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CARDIAC CLASSICS 



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Anatomic drawings of the heart hy Leonardo da Vinci (1512) 


(Courtesy Carnegie Institution of Washington ) 



CARDIAC CLASSICS 


A Collection of Classic Works on the 
Heart and Circidation with Comprehensive 
Biographic Accounts of the Authors 


Fifty'Two CoiiUihiitions by Fifty>-One Authors 


BY 


FREDRICK A. WILLIUS, M.D , M.S. in Med. 

Chief, Section of Cnrdiology, The Mayo Clinic, Professor of Medicine, 
The Ma^o roundation for Medical Education and Research, The 
Graduate School, The Gniaersitv of Minnesota 

AND 

THOMAS E. KEYS, A.B., M.A. 

Reference Librarian, The Mayo Clinic, Formerly Carnegie Fellow, The 
Graduaic Library School, The University of Chicago 


ST LOUIS 

THE C V MOSSY COMPANY 
1941 



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If you do remember, 

I send It through the rivers of your blood, 

Even to the court, the heart, to the seat o’ the brain 
And through the cranks and offices of man. 

The strongest nerves and small inferior veins 
From me receive that natural competency 
XX'^hcreby they live 

— ^William Shakespeare Act 1, Scene 1, Coriolanus 




FOREWORD 


The era of specialualion •which has cliaiacteii/ed medical education 
and practice in the past few jmais has gieatly extended oui kno-wledge 
of all fields of medicine The advances lepicsented m changing con- 
ceptions of disease, new methods of treatment, and radical levision of 
piactice have iiitioduced into medical education an impoitaiit pioblem, 
that of coi relation of accumulated facts and theoiies An understand- 
ing of this con elation is difficult to attain but is equally essential to the 
medical student, tlic gencial jnaetitionei, the siiecialist, and particularlj^ 
the teachci While it is usual! v tiue that advances in any field of 
endeavoi ha‘\e been accomplished thiough specialization, it is also true 
that the piineiples upon vhicli practice should be based have been, and 
piobably vill continue to be, set up by tliose who possess an adequate 
knowledge of geneial medicine and can, theiefoie, coirelate this with 
that aequiied tliiougli intensive iin estigation of aii}'^ special field In the 
fiuther development of specialiration it is essential that education should 
focus on the fact that the bioadei the knowledge of general medicine, 
the 11101 e likely will iin estigalions in any special field prove to be of 
peimanent value 

Medical liteiatuie toda}’' lepiesents these advances, and voluminous 
as the bteiatuie is, it has the vntue of leiteiation, -which is essential in 
education In the appiaisal of medical liteiatuie, students and practi- 
tioneis aie likely to oveilook the wiitings of those who established the 
fundamentals upon which subsequent pi ogress has been made These 
epoch-making contiibutions aie also evidence of the fact that in the 
study of disease thoiough and accuiate obseivation is the first require- 
ment and supeisedes othei methods In the diseases of the heait and circula- 
tion this fact IS paiticulaily tine and in no field of medicine is sound 
clinical sense so impoitant The moibidity and moitality of heart disease 
IS a challenge to the medical piofession which is alieady being met, foi 
leeent statistics in this countiy show a deciease in this mortality rate It 
IS of paiticulai impoitance, theiefoie, that any infoimation which will 
aid the piofession to undei stand bettei these diseases should be widely 
disseminated 

It IS, theiefoie, appiopriate that Di Willius and Mi Keys have 
selected a i epi esentative gioup of classics pei taming to the heait and 
circulation and have added to the inteiest of these by accounts of the 
lives of the authors whose woiks aie included and by a comprehensive 
correlation of the influence of these classics on the development of 
cardiology 

Donald C Balfour 

Eochestei, Mmn 

[ix] 




PREFACE 

The preparation of tins volume of classics on the heart and cii dilation 
was occasioned by seieial motnating influences Our personal apprecia- 
tion of the older medical viitings was the fiist influence to eneomage us 
to undertake this pio.iect Aftci the expcnditiue of consideiable time and 
effoit, ve came to the leali^ation that the inaccessibility of numerous rare 
works undoubtedly detciied many plnsicians, as well as medical students, 
fiom a\ ailing themselves of these lieasuies of the past Furthermore, the 
accelerated tempo of modem times and the voluminous current medical 
liteiatuie alloy many but little time foi the culture of yesteryear How- 
ever, the impoitance of these older wiitings remains unchallenged and 
many of them contain such accurate descriptions based on masterful ob- 
seivation that thes endure as integral paits of the modern concepts of oui 
day 

One cannot lead and contemplate the classics without being aioused 
bj' a desiie to express apologies to the old masteis, for there are many 
modems who have yiitten eeitain lines, believed to be oiigmal, only to 
find that the same obseivations and thoughts were expiessed many years 
befoic It IS leasonable to conclude that the classics of medical antiquity 
foim the basis of modern medicine and that the physician of today re- 
linquishes many cultuial advantages when he avoids acquaintance with his 
distinguished predecessois It is oui hope that this volume mil reward 
the reader with the same measiiie of profit and pleasure that we have 
derived fiom the wisdom of these great masteis 

Di Robert Watt of Glasgow more than 125 years ago wrote “The read- 
ing of the student is too often confined to systems and to compilations which 
are generally the work of men of no experience oi of men writing under 
the influence of preconceived opinions To obtain coriect views of 
medicine, it is necessary to have recourse to original authors, to such as 
write from actual observation, who have seen and treated the diseases 
they describe ” 

We do not presume that we harm incorporated all the cardiac classics 
in the present volume, but we have selected from them those which have 
been of special interest to us and which, we believe, have contributed 
m a large measure to the development and progress of present-day 
cardiology We have selected contributions that deal with the anatomy 
and physiology of the heart and cii dilation, desciiptions of disease, 
pathologic and therapeutic contributions, methods of diagnosis, and the 
like 


[XI] 



We have attempted faithfully to reproduce the original wiitings, and 
where translations from other languages have been undertaken, it is 
our smceie hope that we have aeeuiately expressed the author’s mean- 
ing With few exceptions we have leproduced the writings in their 
entirety, remembering our own feeling of keen disappointment in othei 
years in reading a medical masterpiece that had been radically abridged 
solely by the personal discretion of the compiler There are, however, in 
stances in which the unusual length of a classic oi tedious lepetition 
made certain deletions advisable It is our belief that the rather com- 
plete reproduction of these works is of much gieatei value and peimits 
the leader more fully to appreciate and understand the personality and 
the philosophy of the author, than might be true had deletion been 
practiced 

We have presented the various classics in then chronologic oidei 
and have prefaced each with a biographic account of the author 
Chioiiologie sequence has been earned out with the pin pose of per- 
mitting the progress of cardiology to be leeoided and compared with 
contemporary histone events Whenever possible, note is made of dis- 
crepancies between the date of discovery and the date of publication 
of the contributions included The oidei of then inclusion in this volume 
has been formulated accoiding to date of publication, discrepancies are 
discussed either in the biogiaphic accounts or in footnotes Certain dis- 
agreement concerning dates occurs among vaiious liistoiians, and in so 
fai as possible we have been guided by the dale gnen by Gaiiison 

The first classic included in this volume is the epoch-making contribu- 
tion of AVilliam Haivey, published in 1628 AVe have delibeiately 
avoided eailiei writings, being convinced that Harvey’s Avoik is in lealitj’’ 
the fundamental contiibution on which the modern concepts of the 
anatomy and physiology of the heart and eiiculation are based Genuine 
progress in the field of cardiology first became evident Avhen the vieivs 
of Haivey became generally accepted Oui final classic is Di J B 
Heiiiek’s account of coronary thrombosis which appeared in 1912 

'We wish to acknowledge with gratitude the splendid lesouices of the 
Libiaiy of The Mayo Chine and to express oui appreciation for the 
splendid cooperation of its staff of libiaiians AVe are deeply apprecia- 
tive of the assistance rendered us by Di Maurice AA^alsh of the Mayo 
Clime and Di Eiieli Hausnei, formerly of the Mayo Foundation, in 
translations of works fiom the French and Latin Oui appreciation 
also IS extended to Mi James Eckman, our editor, of the Division of 
Publications of The Mayo Clinic, whose encouiagement and suggestions 
liaA'^e been of great help to us, and also many others whose technical 
assistance has been indispensable 

Fredrick A Willius 
Thojias E Keys 

Rochester, Minn 

[XU] 



CONTENTS 


Page 

Poreword by Dr Donald C Balfour, Director of The Mayo Foundation for Med- 
ical Education and Reseaich, Graduate School, University of Minnesota vn 

The Influence of Certain Caidiac Classics on the Development of Modern 

Caidiology 1 

WILLIAM HARVEY (1578-1657) 13 

An Anatomical Disquisition on the Motion of the Heart and Blood in 

Animals (1628) 19 

PIERRE GASSENDI (1592-1655) 83 

A Nice Observation of the Pciviousness of the Septum of the Heart (1640) 84 

MARCELLO MALPIGHI (1628-1694) 89 

Epistle II — ^About the Lungs (1661) 92 

HIELS STENSEH (1638-1686) 101 

On the Muscular Nature of the Heart (1664) 104 

WELLIAhl COWPER (1666-1709) 107 

Of Ossification or Petrifactions in the Coats of Arteries, Particularly in 

the Valves of the Great Artery (1705) 109 

ANTONY VAN LEEUWENHOEK (1632-1723) 117 

On the Circulation of the Blood in Fishes, Etc (1708) 120 

STEPHEN HALES (1677-1761) 127 

An Account of Some Hydraulic and Hydrostatical Experiments Made on 

the Blood and Blood-Vessels of Animals (1733) 131 

JEAN-BAPTISTE DE SfiNAC (1693-1770) 159 

Operation of Stomachic Remedies m Palpitation (1749) 162 

ALBRECHT VON HALLER (1708-1777) 167 

Description of Calcification of the Heart (1755) 170 

JOHN BAPTIST MORGAGNI (1682-1771) 173 

Descriptions of Mitral Stenosis, Heart Block, Calcareous Stenosis of the 
Aortic Valve With Regurgitation, Coronary Sclerosis, and Aneurysm 
of the Aorta (1761) 177 

JOSEPH LEOPOLD AUENBRUGGER (1722-1809) 191 

On Percussion of the Chest (1761) 194 

WILLIAM HEBERDEN (1710-1801) 217 

Account of a Disorder of the Breast (1772) 221 

WILLIAM WITHERING (1741-1799) 227 

An Account of the Foxglove (1785) 232 

MATTHEW BAILLIE (1761-1823) 255 

Of a Remarkable Transposition of the Viscera (1788) 257 

[xiii 3 



Page 

JOHN HUNTER (1728-1793) 265 

The Record of His Cardiac Historj as Detailed hy Himself and Later 

Puhlished hy His Brotliei-in-Law, Eveiard Home (1791) 269 

JEAN NICOLAS CORVISART (1755 1821) 279 

Essay on the Diseases and Organic Lesions of the Heart (1806) 282 

WILLIAM CHARLES WELLS (1757-1817) 292 

On Rheumatism of the Heart (1812) 294 

JOHN CHEYNE (1777-1836) 315 

A Case of Apoplexy, in Which the Fleshy Pait of the Heart Was Converted 

Into Fat (1818) 317 

RENe THfiOPHILE HYACINTHS LAbNNEC (1781-1826) 323 

Treatise on Mediate Auscultation (1819) 328 

CALEB HILLIER PARRY (1755-1822) 385 

Enlargement of the Thyioid Gland m Connection With Enlargement or 

Palpitation of the Heart (1825) 387 

ROBERT ADAMS (1791-1875) 395 

Cases of Diseases of the Heart, Accompanied With Pathological Observa- 
tions (1827) 397 

JAMES HOPE (1801-1841) — 403 

Treatise on the Diseases of the Heart and Gieat Vessels (1831) 405 

SIR DOMINIC JOHN CORRIGAN (1802-1880) 419 

On Permanent Patency of the Mouth of the Aorta, or Inadeciuacy of the 

Aortic Valves (1832) 422 

JEAN BAPTISTE BOUILLAUD (1796-1881) — 443 

On the Pathology of Endocarditis (1835) 446 

WILLIAM STOKES (1804-1878) 459 

Observations on Some Cases of Permanently Slow Pulse (1846) 462 

WILLIAM SENHOUSE KIRKES (1823-1864) 473 

On Some of the Principal Effects Resulting From the Detachment of Fibrin- 
ous Deposits From the Interior of the Heart, and Their Mixture With 
the Circulating Blood (1852) 474 

WILLIAM STOKES (1804-1878) 

Fatty Degeneration of the Heart (1854) 484 

PAUL LOUIS DUROZIEZ (1826-1897) 492 

The Double Intermittent Murmur Over the Femoral Arteiies as a Sign of 

Aortic Insufficiency (1861) 494 

AUSTIN FLINT (1812-1886) 499 

On Cardiac Murmurs (1862) 502 

PIERRE CARL EDOUARD POTAIN (1825 1901) 531 

On the Movements and Sounds That Take Place in the Jugular Veins (1867) 533 

SIR THOMAS LAUDER BRUNTON (1844-1916) 559 

On the Use of Nitrite of Amyl in Angina Pectoris (1867) 561 

[xiv] 



Page 


HEINRICH lEENAEUS QUINCIOS (18i2-1922) 567 

II Obscivations on Capillaiy and Venons Pulse (1868) 569 

Sm SAIMUEL WILKS (1824-1911) 577 

Capillary Embolism oi Arteiial Pyaemia (1870) 579 

LUDWIG TEAUBE (1818-1876) 587 

A Case of Pulsus Bigeminus, Including Eemaiks on the Enlargement of the 
Livei 111 Valvidai Insufficiency and on Acute Atxophy of the Liver 
(1872) 590 

sm WILLIAhl EICHAED GOWEES (1845-1915) 603 

The State of the Aiteiies in Blight’s Disease (1876) 605 

JULIUS PEIEDEICH COHNHEIM (1839-1884) 615 

The Pathology of the Circulation (1877) 618 

HENEI LOUIS ROGEE (1809-1891) 623 

Clinical Researches on the Congenital Commumcation of the Two Sides of 
the Hearts, by Failure of Occlusion of the Interventricular Septum 

(1879) 624 

Communication Concerning Congenital Patency of the Interventricular 

Septum (1879) 637 

WILLIAM MURRELL (1853-1912) 640 

Nitro-Glycerme as a Remedy foi Angina Pectoris (1879) 642 

PIERRE CARL fiDOUARD POTAIN (1825-1901) 

The Theory of Gallop Rhythm (1885) 652 

AUGUSTUS DESmE WALLER (1856-1922) 654 

A Demonstration on Man of Electromotive Changes Accompanying the 

Heart’s Beat (1887) 656 

JOHN ALEXANDER MacWILLIAM (1857-1937) 665 

Fibnllar Contraction of the Heart (1887) 666 

GRAHAM STEELL (1851 ) 680 

The Murmur of High-Pressuie in the Pulmonary Artery (1888) 680 

eTIENNE-LOUIS ARTHUR FALLOT (1850-1911) 688 

Contribution to the Pathologic Anatomy of Morbus Caeruleus (Cardiac 

Cyanosis) (1888) 689 

WILHELM HIS, JR (1863-1934) 693 

The Function of the Embryonic Heart and Its Significance in the Interpreta- 
tion of the Heart Action m the Adult (1893) 695 

FRANCIS HENRY WILLIAMS (1852-1936) 699 

A Method for More Fully Determining the Outline of the Heart by Means 
of tjc Fiuoroscope Together With Other Uses of This Instrument m 
Medicine (1896) 701 

sm WILLIAM HENRY BROADBENT (1835-1907) 709 

Diseases of the Pericardium (1897) 712 

[xv] 



Page 

WILLEM EINTHOVEN (1860-1927) 719 

Tlie Galvanometric Registration of the Human Electrocardiogram, Like- 
wise a Review of the Use of the Capillary-Electrometer in Physiology 
(1903) 722 

LUDWIG ASCHOFF (1866 ) 731 

Concerning the Question of Myocarditis (1901) 733 

SIR ARTHUR KEITH (1866 ) and MARTIN WILLIAM FLACK (1882- 

1931) 743, 744 

The Form and Nature of the Muscular Connections Between the Primary 

Divisions of the Vertebrate Heart (1907) 747 

SIR JAMES MACKENZIE (1853 1925) 765 

Auricular Fibrillation (1908) 769 

Sir James Mackenzie’s Heart 794 

SIR WILLIAM OSLER (1849-1919) 803 

Chronic Infectious Endocarditis (1909) 807 

JAMES BRYAN HERRICK (1861 ) 815 

Clinical Features of Sudden Obstruction of the Coronary Arteries (1912) 817 

OLIVER WENDELL HOLMES 

The Stethoscope Song — A Professional Ballad 831 

The Correlation of These Classics With Other Contemporary Histone Events 836 

References 840 


[xvi] 



ILLUSTRATIONS 


Page 

Anatomic drawings of tlie Iieait liy Leonardo da Vinci (1512) Frontispiece 

William Haivey Painting liy unknown conteniporaiy 12 

William Harvey expounding Ins conception of the circulation of the blood to 

King Chailes I of England Painting by Robert Hannah 14 

Title-page of Haivey 's moiiogiaph 18 

Veins of the arm showing the return ciiculation (Haivey) 63 

Veins of the aim showing the return circulation (Harvey) 64 

Pierre Gassendi 82 

Marcello Malpighi Portrait by unknown aitist 88 

Lung stnictures (Malpighi) 93 

Lung structiues (Malpighi) 94 

Niels Stensen 100 

Title-page of Stensen ’s book 103 

William Cowper 106 

Aortic valves (Cowper) 110 

Aortic valves (Cowpei) 111 

Antony van Leeuwenhoek 116 

The erythrocytes as Leeuwenhoek saw them in 1696 118 

Pish heart (Leeuwenhoek) 122 

Stephen Hales Portiait by Thomas Hudson 126 

Title-page of Hales’s book 129 

Jean-Baptiste De Senac 158 

Title-page of S6nac’s book 161 

Albrecht von Haller Portrait by Sigmund Preudenbergei 166 

Title-page of Haller’s book 169 

John Baptist Morgagni 172 

Title-page of Moigagni’s book 176 

Leopold Auenbrugger Painted in 1770 by an unknown aitist, restored by Kurz 

von Goldenstein 190 

Title-page of Auenbrugger ’s book 193 

William Heberden Portrait by Sir William Beechey, R A 216 

Title-page of Heberden ’s book 220 

William Withering Painting by Carl Predrik von Breda 226 

William Withering receiving from Old Mother Hutton of Shropshire the recipe 

for her herb tea 228 

Title-page of Withering’s book 231 

Matthew Baillie 254 

John Hunter Painting by Sir Joshua Reynolds 264 

Title-page of Hunter’s book 268 

Jean Nicolas Corvisart Portrait by Charles Bazin, etched by Delpech 278 

[xvu] 



Page 

Title-page of Corvisart’s 1)0011 281 

John Oheyne 314 

Een§ TMophile Hyacmthe Laennec 322 

ThfiopMe Laennec on his rounds in the Necker Hospital in Pans Painting hy 

Chartrau 321 

Title-page of the first American edition of Laennec ’s hook 327 

Laennec’s specifications for making the cyhndei (stethoscope) 330 

Caleb Hillier Pariy Painting hy John Hay Bell, etched hy Philip Audinet — 381 

Eohert Adams 391 

James Hope Engraving 402 

Sir Dominic John Corrigan 118 

Diseased aortic valves (Corrigan) 123 

Jean Baptiste Bouillaud Portrait hy C H Lehman, 1875 412 

Title-page of Bouillaud’s book 415 

William Stokes 458 

William Senhouse Kirkes 472 

Austin riint 198 

Pierre Carl E Potain 530 

Eegistration of cardiac, arterial and venous pulsations (Potain) 537 

Eegistration of pulsations (Potain) 539 

Tracing of jugular pulsations (Potain) 510 

Sir Thomas Lauder Brunton 558 

Heinnch Quincke 566 

Sir Samuel Wilks 576 

Ludwig Trauhe 586 

Tracing of pulsus bigeminus (Trauhe) 592 

Sir William Eichard Gowers 602 

Ocular fundus (Gowers) 607 

Tracing of the pulse in Bright’s disease (Gowers) 608 

Ocular fundus (Gowers) 609 

Julius Fnedrich Cohnheim 614 

Title-page of the Sydenham Society’s translation of Cohnheim ’s ‘'General 

Pathology” 617 

Henri Louis Eoger 622 

Tracings showing effect of amyl nitrite and nitroglycerin on the pulse 

(Murrell) 648 

Electrometer tracmgs (Waller) 657 

Electrometer tracings (Waller) 658 

Electrometer tracing (Waller) 659 

Electrometer tracings (Waller) 660 

John A MacWilliam 664 

Wilhelm His, Jr 692 

Francis Henry Williams 698 

Markings made on human thoiax as determined hy fluoroscopy (Williams) 703 

Markings made on human thorax as determined hy fluoioscopy (Williams) 704 

Sir William Henry Eroadhent 708 


[ will ] 



Page 

Willem Emthoven 718 

Emtlioven’s string galvanometei 720 

Compaiison of tlie electrometei and electrocaidiographic curves (Emthoven) 723 

Electrocardiograms (Emthoven) 726 

Ludwig Aschoff 730 

Sii Aithui Keith 742 

Martin Flack Photograph hy Russell and Sons 745 

A generalized vertebrate heart (Keith and Flack) 749 

Parts of the human heart corresponding to the sinus of the primitive heart 

(Keith and Flack) 750 

Auiicular portion of human heart (Keith and Flack) 751 

Auriculai rings in the mammalian heart (Keith and Flack) 752 

Right auricle of human heart showmg musculature (Keith and Flack) 755 

Serial sections of the sino-auricular junction in the human and turtle heart 

(Keith and Flack) 756 

Blood supply of the smo-auncular junction (Keith and Flack) 756 

Coronal section of mole’s heart showing musculature at smo-auncular junction 

(Keith and Flack) 757 

Sir James Mackenzie Photograph hy Emery Walker 764 

Polygraphic tracings of auricular fibrillation (Mackenzie) 771 

Polygraphic tracings of auncular fibrillation (Mackenzie) 773 

Diagrams illustrating murmurs m mitral stenosis when auricular fibrillation 

occurs (Mackenzie) 781 

Charts showmg effects of digitalis m slowing the heart rate in auricular fibrilla- 
tion (Mackenzie) 782 

Sir William Osier Crayon portrait by John Smger Sargent 802 

James Bryan Herrick 814 

Oliver Wendell Holmes 830 






CARDIAC CLASSICS 


THE INFLUENCE OF CERTAIN CARDIAC CLASSICS ON 
THE DEVELOPMENT OF MODERN CARDIOLOGY 

I N THE liistoiy of medicine aie leeorded the heioie effoits of man over the 
niilaiown, the conflicts against ignoiance, supeistition, and piejudice, le- 
lentless self-saciifice in the search foi tiuth, indomitable courage in the face 
of failiiie and disappointment, all a part of the maivelous yet uncompleted 
pageant of present-daj’' medicine In the ehionologic presentation of these 
classics on the heait and cii dilation it is possible to tiaee the development 
of cardiology to its piesent position It is probable that the advancement 
of loioivledge in the century to follow the piesent one will be gi eater and 
inoie dramatic than that of the tliiee pieeeding centuries comprising 
the scope of this volume, but if this piedietion mateiializes, it will be only 
because our illustiious piedecessois have built then struetuie well and 
msely 

Theie is no doubt that William Harvey’s epoch-making contribution, 
published in 1628, on the anatomy and the phj’-siology of the heart and 
circulation laid the foundation for subsequent discoveiies and advance- 
ments m this field Eailiei obseivations aie unceitain, isolated, and lack 
co-oidmated continuity, some aie eiioneous and speculative, pioduets of 
the ages of scientific ignoiance, leligous piejudiee, and supeistition We 
do not mean to deny the fact that ceitain earlier obseivations weie note- 
woitliy, but their sporadic occuirence in the space of time haidly peimits 
their inclusion in this consideiation Even Haivey’s views ivere bitteily 
contested by many of his contempoiaiies, who found it simplei to disagiee 
on the premise of eiioneous doctiines accepted as fact, lather than to open 
their minds to the compiehension of new data demonsti ated by dissection 
and expel iment Haivey proved the cii dilation of the blood and the 

manner in which it was accomplished, he also piedieted the existence of the 
capillaiy circulation, which he leferred to as "pores ” He pieceded tlie 
era of the microscope, and the use of his magnifying glass was of course 
inadequate for the demonstration of this minute anastomosis Howevei, 
through lemaikably deal leasoniiig he realized that some manner of com- 
munication between the teiminal arterial and venous tributaiies must exist 
in order to con elate the various observations which weie evident fiom 
his thoiough and painstaking investigations 
In 1640, Fieri e Gassendi lecorded the demonsti ation of the existence 
of the f 01 amen ovale in the adult heait Gassendi witnessed this demon- 
stration, which was made by a suigeon named Payanus in Aix dm mg tlie 
dissection of a human body This eaily settlement of a eontioversial 

[ 1 ] 



issue of that eia is of unusual interest and leveals the meticulous caie 
exercised by some of the oldei anatomists in caiiymg out then dissections 
With the advent of and impiovement in tlic imcioscope, the oppoitunil'^ 
of demonstrating the capillai^ circulation, and theiebv vcrifiing Haney’s 
prediction, was accoided Maicello Malpighi, wlio vividly desciibcd these 
minute vasculai structuies in the lung and mesenteiy of the frog These 
observations were recoided in 1661, in his classic Ictteis to Boiclli, pio- 
fessor of science at Pisa, his friend and ci sin bile idol 
Thiee years latei, in 1664, Niels Slensen levealed the tiiic musciilai 
nature of the heait This was a most important obscnation, because sub- 
sequent studies on the acluits of the lieail found confiimation m this 
fundamental demonstration 

Thus, the teaching oi eoiieet basic anatomic and pl^siologic piinciplcs, 
though limited in scope, uas the pioncei influence for the bctlei undci- 
standing and leeognition of dopai tines fiom noimal in the fields of 
physiology, pathology, and elimcal medicine 
In 1705, William Cowpei cleaih desciibcd disease of the aoitie lalvc 
with aortic insufficienci This uas accomplished thiough keen obscnation 
by eoirelatmg the sjmiptoms oi the patient and altciations detected in 
the pulse with the abnoiraal findings in the heait rs icicalcd by post- 
moitem examination It must be iceallcd that tins obscnation antedated 
the diseoveiy of auscultation by moie than a ccntinj 
Antony lan Leeuueuhoek, in 1708, published Ins conception of “that 
motion which we call the pulse” Although his obscnations in this 
study weie inaccurate and his conclusions eiioneoiis, his noteuoithy 
contributions m micioscopy place him dcsencdly among science’s im- 
moitals, foi his mechanical ingenuity and moidinatc patience enabled 
many biilliant successois to contiibute geiieiouslv to the adianccmcnt of 
cardiology 

A quarter of a centuiy latex (1733) Stephen Hales, a scientificalh 
minded eleigyman, published the lesults of Ins rathei unique cxpciimcnts 
on blood pressine and blood velocity This uas the fust outstanding 
eontiibution on the physiology of the caidiovasculai system following 
the exposition of Haivey These obseivations ueic made possible by the 
collect teaching of basic anatomic pnnciples and yet little oi nothing’ 
was known regaiding hemodynamics These cxiieiiments, conducted on 
living animals, were the fiist in which an attempt at actual measinement 
of blood piessine and blood velocity in vaiious paits of the eneulatoiv 
system was undei taken They leimaled eeitani fundamental facts upon 
which the modern concepts of today aie largely dependent 
In 1749, Jean Baptiste Dc Senac made a most exliaoidniaiv obseiiation 
which mthout a doubt is the veiy beginning of the lelatneh modem 
quinidine therapy of caidiae aiihythmia Although moie than a eeiituij’' 
II a half elapsed before the medical wmrld became cognizant of the 

[ 2 ] 



value o£ quinidine, De Senac clearly described tlie beneficial effects of 
qimiiiie in “rebellious palpitation ” 

Albieclit von Haller, in 1755, described calcification of the heait and 
pericardium in a very clear and vivid manner This observation was 
based on a stud}’’ of post-mortem material 

In 1761, the interesting and important observations of John Baptist 
Morgagni were published They appeared m the form of letters collected 
in five books under the title of The Seats and Causes of Diseases, etc 
(tiaiis ) Tins work comprises the descriptions of a wide variety of dis- 
eases, with post-moitem obseivations The remaikably accuiate and in- 
teiesting manner of presentation of Morgagni prompted us to leprmt his 
obseivations on mitral stenosis, heart block, calcareous stenosis of the 
aortic valve with insufficiency, coronaiy scleiosis, and aneurysm of the 
aoita Studies of this chaiacter were of great importance in the develop- 
ment of medicine because they lepiesented the correlation of clinical symp- 
toms and signs with dissection after death Although the concepts of 
pathology were still ill-defined, observations of changes in tissue were 
recorded even though their nature and significance were not always under- 
stood Such reeoids seived to stimulate others to pursue similar investiga- 
tions with a determined cuiiosity 

Also in 1761, Leopold Auenbrugger published the lesults of his investiga- 
tions dealing ivith a new diagnostic method, peicussion of the thorax This 
work preceded the introduction of auscultation by fifty-eight yeais He 
introduced the Pieface of ins woik with the folioiving words, “I heie 
present the Reader with a new sign which I have discovered for detecting 
diseases of the chest This consists in the Percussion of the human 
thorax, wheieby, according to the chaiacter of the peculiar sound thence 
elicited, an opinion is formed of the internal states of that cavity” 
(tians ) The tremendous influence of this discovery on the science 
and art of physical diagnosis requires no special comment It enabled 
the physician to use an additional method of clinical investigation, since 
his methods weie still limited to his own senses of perception 

In 1772, William Heberden’s classic description of angina pectoris 
was fiist published, and agam it appeared in 1802 in his Gommentanes on 
the Histoiy and Owe of Diseases Heberden, an outstanding scholar of 
his day, was possessed of the art of clear and accurate description, so that 
ins vivid portiayal of the symptoms of angina pectoris, recorded in re- 
markable claiity, stands unchallenged today and is without a doubt one 
of the most cherished and brilliant masterpieces of the past 

WiUiam Witheiing, in 1785, pubhshed the lesults of years of study and 
observation and gave to the woild a drug of inestunable and enduring 
value, digitalis He was a botanist of nude expeiience, in addition to being 
a much respected physician His concise comments on the use and actions 
of the foxglove (Digitalis pwpwea) in caidiac diopsy, his lemaikable 

[ 3 ] 



understanding of the indications and contiaindications of tlic diug, his 
admonitions legaiding its indisciiminate employment, and his warnings 
lelative to ovei dosage enduie today as the veiy basis of digitalis theiapy 
Withering was one of science’s most humble seivants, as the intioductoiy 
sentence of his Piefaee testifies “Aftei being fiequently uiged to yiite 
upon this subject, and as often declining to do it, fioin appiehension of 
my own inability, I am at length compelled to take up the lien, how- 
evei unqualified I may still feel myself foi the task ” llis disscitation 
becomes more inteiesting and lemaikable when it is lecallcd that the 
era in which he lived saw theiapeuties in the zenith of empiiieism Dings 
of unknown and unceitain action Aveie administeicd by the method of 
tiial and eiror, standaidization of piepaiations was unkno-nn oi uncei- 
tain, and therapeutics to a laige extent became a tiadition peipetuated 
by word of mouth 

In 1788, Matthew Baillie pictiuesquely desciibcd the findings after 
death in a case of congenital dextiocaidia with complete situs tians- 
veisus In this publication he philosophized in a leiy inteiesting and 
understanding mannei on the oiigiii of the condition Baillie is par- 
ticularly noted for his interest in pathology, and he vas iiiobably the 
fiist physician to emphasize moibid anatomy as a definitnc bianch of 
medical science He investigated the morbid changes in laiious organs 
and attempted to eoiielate them in the indnidual case His studies 
unquestionably wrought an impoitant influence in the field of pathology 
and in no small measuie eontiibuted to the gioundivoik of that science 

John Hunter, the celebrated English surgeon, lathei unfittingly con- 
tiibuted to the piogiess of caidiology tluough the peisonal lecoids 
of his own illness He suffeied severe, lecuiient attacks of angina 
pectoris, and his obseivations and deseiiptions of the symptoms and 
signs of the disorder weie the first lecoided by a physician suffering 
from this disease The intimate aspects of his illness are extremely 
interesting, as aie also his various and sundry theiaiieutic attempts at 
lelief in an eia in which theiapeutic effort was, to say the least, ex- 
tremely discouraging This account ivas published by his biothei-in-law, 
Eveiard Home, in 1794, three years after Huntei ’s death Post-mortem 
examination of Huntei levealed marked sclerosis of the coronary arteries 
which was vividly described nr the following words “The coionaiy 
arteries had then branches which ramify through the substance of the 
heart in the state of bony tubes, which were vutli difficulty divided 
by the knife, and then transverse sections did not collapse, but lemained 
open ” This is one of the early accounts demonstiatnig the coexistence 
of angina pectoris and coronary sclerosis 

In 1806, Jean Nicolas Corvisait irublished his treatise on diseases of 
the heart This was a comprehensive consideration of the diseases of 
the heart and great vessels according to the knowledge of that era He 

[ 4 ] 



emphasized percussion as an impoi’tant diagnostic method, and his in- 
fluence midoiibtedl}'’ had great influence in its survival, for Auen- 
brugger’s teachings liad not been enthusiastically leceived by his con- 
temporaries Laennee, one of Corvisart’s illustiious students, was 
greatly stimulated by his able teachei, as evidenced by the frequent cita- 
tion of Gorvisart in Laennec’s treatise on auscultation 
WiUiaiii Charles Wells, in 1812, published one of the eailiest clinical ac- 
counts of the caidiac paiticipatioii in rheumatic fever, which he designated 
as iheumatism of the heait His observations pieeeded the disco veiy of 
auscultation and his observations compiised the recoid of symptoms lefei- 
able to the heart and alterations occuiring in the pulse, notably tachy- 
cardia and iiregularitj’’ In seveial instances post-moitem examination 
confirmed Wells’s clinical suspicions The recognition of iheumatic fevei as 
a causatii e f actoi in heai t disease was to become an important conti ibution 
111 the field of etiology 

Clinical observations were recoided with gieatei fiequency as the nine- 
teenth cent 111 V progressed, and one of the striking developments was the 
evident desiie to eon elate s 3 ’'mptoms and signs of disease with post-mortem 
obseivations A typical instance of keen obseivation was that of John 
Chejnie, who, in 1818, desciibed an unusual form of periodic bieathing in 
an mstance of fatty heart, which was again described in 1846 by William 
Stokes, and ultimately became known as “ Cheyne-Stokes respnation ” In 
both of these accounts of the disoidei, the descriptions aie vividly eleai 
and impiessive, and testify to the ait of caieful obseivation and expression 
In 1819 a new and veiy fiuitful method of clinical examination was 
intioduced in Eene T H Laennee ’s epoch-malang conti ibution of ausculta- 
tion With the acceptance and refinement of this method, progress in 
the diagnosis of diseases of the heart advanced in great stiides This 
discovery was, in a large measure, diiectly responsible for the great ad- 
vances in cardiology that weie destined to occur in Laennec’s eentuij^ 
In fairly rapid succession, many important observations and discoveries 
ensued, of which we are able to reproduce only certain outstanding classics 
Caleb Hillier Parry, in 1768, Avas the fiist to recognize exophthalmic 
goitei and its eaidiovasculai phenomena This work, however, v'as not 
published until 1825 

Two years latei (1827) Eobeit Adams presented his classic desciiption 
of heart block, which Avas again described by William Stokes in 1854, and 
the ceiebial phenomena at times present in tins disoidei later became 
loioAvn as the “Adams-Stokes syndrome ” 

In 1831, James Hope published a lemarkably complete treatise on dis- 
eases of the heait and great vessels Numerous inteiesting and giaphie 
descriptions are contained in this AAmik Of unusual inteiest aie his dis- 

*AVe again wish to remind the leader that the chronologic sequence of presentation in 
this volume is governed by the i ear of publication and not necessarilj m the ^ ear in 
which the obseivation or work vas earned out — F A AA’" 1940 

[5] 



cessions of caidiac asthma, stenosis of the pulmonaiy v.ilvcs, and caidiac 
neurosis Of partienlai impoitance is Hope’s discussion of caidiac 
asthma, because this syndiome was then only laiely identified as being 
of cardiac origin 

Sir Dominic John Coiiigan, in 1832, published his classic dcsciiption 
of the pulse in aoitie insufficiency This obseivation was impoitant fiom 
more than the standpoint of diagnosis, foi it stimulated inteiest and 
thought on the vaseulai mechanics of this vahulai lesion ITeic again 
IS portrayed aeeuiate and masteiful deseiiption of keen obsoiiation 

In 1835, Jean-Baptiste Bouillaud, an eminent phjsician of his eia, 
among othei impoitant contiibutions desciibed the pathologic aspects 
of endocaiditis according to the knowledge of his time and undoubtedly 
stimulated otheis to inquiie fiiithei into the endocai ditides 

Six yeais later, William Senhouse Kiikes desciibed and discussed 
emboli lesultmg fioin intiacaidiac coagula and collected the existing 
tenets aseiibing the i emote lesions to local disease (so-called capillaiy 
phlebitis) This woik was especially impoitant in siippoiting the 
theory of emboli Minute and gioss visccial infaictioii is desciibed in a 
clear and undei standing mannei 

Additional obseivations legaiding the signs of alieady iccognwcd 
diseases began to appeal, and in 18G1 Paul Louis Dm 0 / 10 / desciibed 
the auscultatoiy findings audible in eeitain peii])heinl aiteiies, iiotablv 
the femoral aiteiies, in the piesencc of aoitic insufficicne\ lie icfciied 
to this phenomenon as the “double intcimittent nmiimii o\ei tlie fcinoial 
(ciuial) arteiies” (tians ), which latci Mas to be known as “Diuo/ie/’ 
sign ’’ 

In this eia of medicine, the teaching of clinical caidiology laigelj’’ 
centered around muimuis, and much emphasis wxas placed on the desciip- 
tion of their chaiactei, slight variations in timbie and intensity, timing 
and transmission This period of the history of cardiology witnessed 
many significant advances and stimulated physicians to seaicli for new 
and additional diagnostic methods to peiietiate still fiuthei the secrets 
of the normal, as well as of the diseased, heart It wms 111 1862 that 
Austin Flint, an Ameiican physician, published his impoitant contiibu- 
tion, “On Caidiac Muimuis,’’ which appeared 111 the Amciican Jownal 
of the Medical Sciences This papei deals compi ehensively wath muimuis 
in geneial and contains the description of the muiniui, latei to be known 
as the “Austin Flint muimui ” 

In 1867, Pierre Call E Potain called attention to the impoitance and 
significance of another peripheial phenomenon of heart disease in his 
obseivations on the pulsations of the jugulai veins Evidence more 01 less 
remote fiom the heait was gradually being accumulated and coi related, 
helping to lay the foundation foi the iiinumeiable signs that now constitute 
the diagnostic aimamentaiium of the piesent-day physician 

[ 6 ] 



Ill the same year, Sir Thomas Laiidei Bruntoii enriched the woild with 
the important contrilmtioii relative to the ameliorating effects of amyl 
nitrite in the anginal syndrome Preceding this discoveiy, sufferers from 
angina pectoiis had leeeived little or no lelief fiom the therapeutic agents 
available to them In this study the vasodilating action of amyl nitrite, 
first suspected by Dr B W Ricliaidson, was confirmed The drug was 
discovered by Balard, but Bruntoii was the first to suggest its use on a 
piactical therapeutic basis Studies of tins character were extremely im- 
poilant 111 the attack on the existing theiapeutic empiricism of that eia 

A yeai latei (1868) Hemrieh Iienaeus Quincke cleaily desciibed the 
capillary and venous pulse Quincke was anothei keen observer who called 
attention to more remote signs of the impaired heart These observations 
were significant and continue to be of great practical importance today 

In 1870, Sir Samuel Wilks very clearly described the disease later to be 
known as “bacterial endocarditis,” under the title “capillary embolism 
or arterial pyaemia ” This contribution was important in that it called 
attention to the necessity for separating old valvular defects (healed 
endocarditis) from associated or superimposed vegetative lesions resulting 
in the dissemination of emboli 

Ludwig Tiaube, two j^ais later (1872), described a significant disturb- 
ance m the pulse which he termed “pulsus alternans ” He clearly dis- 
tinguished it from the simulating condition, pulsus bigeminus Traube’s 
contribution has endured as a very valuable sign and today continues to 
guide the clinician in his appraisal of the course of the failing heart 

In 1876, Sir William Ei chard Gowers graphically described certain 
clianges found in the retinal vessels in the presence of arterial hypei ten- 
sion This demonstiation was destined to be of great importance, as testi- 
fied to by the extensive development of retinoscopy in recent years He fully 
appreciated the fact that the retinal arteries, visible by special means, 
afforded the physician an opportunity of actually observing vessels during 
the life of the patient and of compaimg the retinas of normal individuals 
with those of patients afflicted with cardiovascular-ienal disease At the 
time that Gowers conducted these studies, the concept of primary renal 
damage occupied a very prominent position, and the concept of geneialized 
vascular disease in relationship to hypei tension had not yet been clearly 
conceived 

A year later (1877), Julius Friedrich Cohnlieim in his chapter on 
tliiombosis and embolism of his work on the Pathology of the 0%iculahon 
(trans ) described paradoxical embolism This voik called attention to a 
new significance attending otherwise innocuous imperfections of the 
septa of the heart and demonstrated the manner in which, in the pi esencc 
of these imperfections, thrombi arising m the venous system can be trans- 
ported to the periphery of the arterial system 

cn 



In 1879, Henu Eogei described the nncoinplicatcd congenit.il defect of 
the mteiA’^entiiculai septnni and mastciiiilly desenbed the prolonged 
mnrinni, extending thioiigh both systole and diastole, iialhognomonic 
of this defect The mnimiii is still fiequently known as the “Eogei 
murmni “ 

In the same yeai, William Muiiell, undoubtedly influenced by Ihe woik 
of his worthy predecessor. Sir Thomas Lauder Li unton, published his 
studies on the effects of nitioglyceiin in angina pectoris In this in- 
vestigation, conducted during a controversial period because of a lack 
of standardization of drugs, he piusued Ins studies in a detei mined 
manner and compared the effects of nitroglycerin uith those of amjl 
nitiite This contribution made aAmilable another valuable diug foi 
the mitigation of the anginal sei/uie It also stressed the importance 
of standardization of drugs 

Six years later (1885) Pieiie Carl Potain made anothei impoitant 
contribution to cardiology He published his studies on gallop ilijthni 
and presented his views on the genesis and significance of this condition 
Augustus D AVallei, in 1887, after extensne plnsiologic studies on 
the action currents of the heart by means of the capillary elcctiomctei, 
published his work on a method of leading the cun cuts from the sui- 
face of the body by means of paired electrodes Picmous voik iii this 
field had necessitated direct contact Avith the heart His studies eleaih 
paved the way for clinical electiocaidiogiaphy, an almost indispensable 
method of modern cardiology 

In the same year, John Alexander MacWilliam recorded the results 
of his experiments dealing Avith direct faradization of the heart, and 
produced profound alterations in rate and rhythm He clearly dcsciibcd 
the abnormal rhythms now known as “auricular fibrillation,” “auiiculai 
flutter,” “ventricular tachycardia” and “ventricular fibrillation ” Ills 
work, moreover, was a steppingstone to clinical electiocaidiogiaphy, 
particularly from the standpoint of the ultimate coiielation of graphs 
revealing abnormal waves with actual visualization of induced disturbances 
in the hearts of animals 

A year later (1888), Griaham Steell described the pulmonary diastolic 
murmur, under the title of “The Murmur of High Pressure in the Pul- 
monary Artery ” This was destined to be known as the “Graham 
Steell murmur,” aird is so designated today 

In the same year, A Fallot described the interesting and unusual com- 
bination of congenital cardiac defects consisting of pulmonary stenosis, 
inter ventiieulai septal defect, dextioirosition of the aorta, and hyper- 
trophy of the rrght ventrrcle This became known as the tetialogy of 
Fallot and is frequently referred to as the maladie hleue 
At this time, very little was known regarding the intrinsic physiologj^ 
of the cardiac impulse and its dissemination through the substance of the 

[ 8 ] 



heait It was in 1893 that Wilhelm liis, Ji , accurately desciibed the 
minute fasciculus that conducts the imiiulse fiom the auiicles to the ven- 
tricles the auiieuloventiicular bundle This stiuctiue is still fiequently 
designated as the “bundle of His ” This contiibution was of paramount 
importance in the cleaiei undeistanding of the intricate mechanism of 
cardiac conduction and inevitably led to fuithei discoveries m this field 

In 1896, Francis Heiiiy Williams of Boston lepoited his observations 
on the fluoroscopic examination of the heait and aoita Although his 
studies weie not the fiist leeoided, they aie extiemely noteworthy and we 
have chosen to include them in this volume Williams’ observations weie 
published a year following Roentgen’s oiiginal observations and siiiely 
lepresent pioneei effoits in this lemaikable bianch of science 

The following year (1897), Sii William Henry Bioadbent piesented his 
classic description of adheient perieaiditis and described the lecession of 
the intei costal spaces as a sign of this disease, a sign which was to become 
known as “Bioadbent’s sign ’’ Simulating findings have since been lie- 
qiientlv misintei preted, yet Bioadbent emphatically discussed the limita- 
tions of inteipretation 

In 1903, Willem Einthoven devised the stung galvanometei, the oiiginal 
modem electrocaidiograph Dining his extensive experience with the 
capillary clectiometei in the study of the action cm rents of the heait, he 
was aware of the inheient eiioi existing in this method and sought to 
devise a method of legistiation wheiein this eiior would be obviated The 
world owes this humble scientist a tiemendons debt of giatitude for his 
biilliant gift, for with the advent of eleetioeaidiogiaphy, lemaikable piog- 
less has been made, and many of the seciets of the heait have giadnally 
become baied Electioeaidiography is today viitiially an indispensable 
method m the thoiough appiaisal of the heart 

A yeai later (1904), during the time that the issue between the mj'-ogenie 
and neuiogemc theoiies of heait contiaction was contioveisial, Ludwig 
Aschoff piesented his epoch-making woik on iheumatic myocaiditis He 
desciibed the chaiacteristic lesion of iheumatic fevei, which has come to 
be knovm as the “Aschoff nodule ” This was a monumental woik and did 
much to crystallize the present-day concepts of the pathology of this yet 
unsolved disease and it established a histopathologic pietuie that was 
destined to exeit a gieat influence in classifying examples of tiue myo- 
caiditis Other myocaidial abnoimalities, latei to be pioved noninflam- 
matory in natuie, weie before this univei sally shuffled into the latliei 
vague category of “myocaiditis ” 

It was not until 1907 that the smo-amiculai node was demonstiated 
by the painstaking niicioscopic studies of Aithui Keith and Martin 
Flack They also piedieted the function of this node to be the “pace- 
makei” of the heart, that is, the point of oiigin of the caidiae impulse 
This diseoveiy pioved to be of gieat impoitance m budging ceitain gaps 

[9] 



in tlie inoie coiiipielicnsivo iniclci standing of the intrinsic anatomy and 
physiology oi the iieail 

Sii Janies Mackenzie contiibntcd goneionslj to the modem concepts of 
caidiology, but the identification and clai ific.ition of auiiciihii hin illa- 
tion was piobably one of his gic.itesl .ichie\ ements The conelusiye 
publication of this woik .qipeaied in 1008, .illhough he desciibcd this 
foim of aiihythniia in 1902, belieiing tlicii that it lejnesented “nodal 
ihj’^thni ’’ Ills clinical obsenations on the pulse and the difCcientiation 
and segiegation of the yaiioiis in egiil.ii dies of the jnilse -ncie made 
possible by his adoption ol the simullancoiis lecoiding of aiteiial and 
venous pulse wa\cs In nio.ins of the pol\!>:i.iph This mechanical method 
of legistiation uas e\en1ually siiiiiilanted b;\ the elcclioeaidiogiaph, in 
a gieat measiuc thiough the eonipi chensn c studies of Mackenzie’s 
biilliant student, Sii Thomas Lewis 

At this time anothci outstanding plnsiciaii was molding the foim of 
modem mcdieine, ,ind his Aaiicd conti ibutions .11 c still the b^wold of 
piesent-day medical students Sii AVilli.im Oslei ’s infiiicnce on modem 
medicine was piofound We ha\o chosen to leinoduce his .11 tide on 
ehionic infectious endocaulitis, jniblishcd in 1909, whciein the dcsciip- 
tion of the cutaneous nodules of subacute bacteiial endocaulitis is found 
These pathognomonic lesions <11 e wideh Known toda\ as “Oslei s nodes ’’ 

Oui final contiibutoi, one of the few masteis still Iniiig, is oui bcloAcd 
Ameiican, Di James Dn.ui Ileiiick llis classic dcsciiption of coionaij 
thrombosis, appealing in 1912 in the Jounuil of ihc Amcncun Mcchcal 
Assocmiion, clcaih opened a new cia in which the clinical lecognition of 
this disease w'as to bocome tlie lulc lathci than the exception Although 
this lepoit was picccdcd bj that ol Di Adam llamniei of St Louis and 
Vienna in 1S7S, Ilciiick’s papci attiactcd much widci attention and thcie- 
foie appeals to hace had a moie piofound infiucncc on the modem con- 
cepts of the disease than tliat of Ilammci 

It has been impossible to include ail notcwoitln conti ilnitions of the 
past in this volume of Cvrdiac Classics, and tlicic will be some ciities who 
wall disappiove of ccitain melusions w'hile otlicis will question ecitain ex- 
clusions In the anticipation of such ciiticisnis we can but slate, simph, 
that Ave have conscientiously attempted to make this collection of classics 
comprehensive, and have selected iiom the gieat lileiatuie of the thiec 
centimes pieceding oui owm those conti ibutions which haic paiticulaih 
appealed to us and wdiich, w'c believe, have pioioundh" influenced the 
piogiess of this blanch of medical science We have, as iai as possible, 
avoided the inclusion of the wmiks of liAuiig physicians, ivell lealiziiig the 
possibilities foi conti ovcisy wdiich wmuld have aiisen if such a plan had 
been extensively adopted Theie aie, of eouise, many notable conti ibutions 
by our living eontempoiaiies, wdio, how^evei, must lemain patient until 
some future compileis honoi them in a mannei similai to that adumbiated 
by the present collection 


[ 10 ] 



1628 

WILLIAM HARVEY 

ON THE MOTION OF THE HEART AND BLOOD 

IN ANIMALS 




WILLIAM HARVEY 

(1578-1657) 

“Cor, Imperator, Rex” 

“I tons almost tempted to think with Fiacastonus that the motion of the 
heait was only to he comprehended hy God ” 

— ^William Harvey, Chapter I, Be motu cordis 

(JT ^TlfLlAM HARVEY", horn in 1578 as the eldest son of Thomas Harvey of 
UiZ/ Folkestone, Kent, had his preliminary education at the Canterbury Grammar 
School and was admitted as a student of Cams' College, Cambridge, m 1593 Dr 
Cams, the founder and long the master according to Power (p 13), in addition to 
his knowledge of Greek, mtroduced the study of practical anatomy into England 
Through his mfluence, his college was allowed to use the bodies of two criminals 
annually for the purposes of dissection It is not definitely known whether or not 
Harvey was permitted to watch or to participate m dissections, but it is known 
that he was graduated from this school. Bachelor of Arts, in 1597 His collegiate 
education probably was a general one and mcluded a sound knowledge of Greek and 
Latin plus an accLuamtanceship with dialectics and with physics 

In choosmg Padua for the study of medicine, Harvey was no doubt drawn by the 
renown of its medical school, made famous by the great Vesalms and by the work 
of the successor of Vesalms, Hieronymus Fabricius Harvey supposedly entered 
Padua in 1598, but there is no record of his bemg there before the year 1600 

The theater in which Fabncms lectured still exists It is now an ancient struc- 
ture contaming seats which rise perpendicularly, one above the other. But when 
Harvey was at Padua the theater was new, and the government had placed an in- 
scription over the entrance to commemorate the genius of Fabncius Fabncius must 
have been a source of great inspiration to Harvey and it was under hun that the 
young student became an expert m anatomy Harvey makes reference m ‘ ‘De motu 
cordis” to his former teacher as ‘‘the celebrated Hieronymus Fabncius of 
Aquapendente, a most skilful anatomist, and venerable old man ’ ’ "While Harvey was 
receiving his medical trainmg at Hadua, Fabncms was perf ectmg his knowledge con- 
cerning the valves of the veins Sylvius of Louvilly (Jacques DuBois, 1478-1555), 
the teacher of Vesalms at Pans, had known and described the valves at an early 
date But Fabncms rediscovered them m 1574 (Power, p 25) Fabncms, as Harvey 
so skillfully points out, did not rightly understand the function of the valves 
Fabncms thought their purpose was to prevent overdistention of the vessels when 
blood flowed from the larger into the smaller veins, but that they were not needed 
in the arteries because the blood was always in a state of ebb and flow' Harvey 
pointed out that the true function of the valves was to prevent venous reflux and, 
therefore, this prevention of contrary motion was a great factor in the circulation of 
the blood 

After a flve-year stay at Padua, Harvey received his diploma as Doctor of Physics 
(1602), with the nght to practice and teach arts and medicme m every land and seat 
of learning Apparently, Harvey had made a great impression on his supenors, for 
his diploma further stated, ‘‘He had conducted himself so wonderfully well m the 

[13] 





examination, and liad shown such skill, memory, and learning that he had far sur- 
passed even the great hopes which his examiners had formed of him ’ ’ (Quoted hy 
Power, pp 26-27 ) 

On his return to England in the same year, Harvey also received the degree of 
Doctor of Medicine from the University of Cambridge Two years later (1604), 
Harvey settled in London, married the daughter of a physician (Lancelot Browne, 
physician to Queen Elizabeth and to King James I) by whom, it is to be regretted, 
he had no children He then entered the practice of his profession and was elected 
a fellow of the College of Physicians in 1607 In 1609 he was duly appointed 
physician to St Bartholomew’s Hospital 

In 1615 Harvey was appointed to the office of Lumleian lecturer, a highly esteemed 
position under the sponsorship of the College of Physicians He continued in this 
capacity until 1656, when he resigned his post Harvey’s lectures (on anatomy and 
surgery as qualified by the Lumleian Trust) were first delivered from April 16 to 18, 
1616. On April 23 of that same year, Shakespeare died at Stratford-on-Avon. 
Garrison (p 249) and others have pointed out the resemblance of Harvey’s finely 
formed head to that of the world’s greatest dramatist And it may be possible that 
Harvey was influenced somewhat by his great contemporary 

The manuscript notes of his first course of lectures are now the sacred property 
of the British Museum The second portion of his notes (as described by Power, 
pp 64-66) contains an account of the thorax and its contents After a full discussion 
of the situation and functions of the various abdommal viscera, Harvey next con- 
sidered the thorax, and his remarkable words contain his first written description 
of his memorable discovery These words are initialed to show that Harvey believed 
the idea was original 

“It IS plain from the structure of the heart that the blood is passed contmuously 
through the lungs to the aorta as by the two clacks of a water bellows to raise 
water 

“It is shown by the application of a ligature that the passage of the blood is from 
the arteries into the veins 

“Whence it follows that the movement of the blood is constantly in a circle, and 
IS brought about by the beat of the heart It is a question, therefore, whether this 
IS for the sake of nourishment or rather for the preservation of the blood and the 
Irnibs by the communication of the heat, the blood cooled by warming the limbs 
being in turn warmed by the heart ’ ’ 

Therefore, it is apparent that Harvey knew of the circulation, at least, by the 
year 1616, at the age of thirty-seven, and twelve years before the publication of 
“De motu cordis ’’ 

In 1618 Harvey was appomted Physician Extraordinary to James I and, on the 
death of that monarch, his son, Charles I, appointed Harvey a physician-m-ordinary 
Besides being physician to tbe King’s household, Harvey was physician to several 
distinguished noble families Included among his patients was Prancis Bacon 
(1561-1626), whose great gemus did not impress the mind of Harvey, who said of 
one of Bacon’s works, “He writes philosophy like a Lord Chancellor ’’ 

The year 1628 marks the highest point in the career of William Harvey Prom 
Frankfort-on-the-Mam came his matured account in Latin of the circulation of the 
blood The Italians claimed Andrea Cesalpinoi (1524-1603), professor of medicme 

>Brasisti atus (circa 310-250 B c ) of Keos, the first experimental phvsiologist, described 
the aortic and pulmonarj valves, the chordae tendmeae of the heart and had the idea of the 
capillary system He also conceived that the heart vas a pump and expressed the first 
theory of the circulation ( See Finlayson J Hierophilus and Erasistratus Glasgow M J 
39 321-352, 1893 ) Others in addition to Cesalpino who contributed more or less meritorious 
theoretical accounts of the circulatory sjstem included Ibn an- Nafis, of Eg>pt and Syria 
(c 1288-1289), Servetus (1509-1553), the Spaniard, and Realdo Colombo (1516-1559), the 
successor of Vesalius at Padua 


[ 15 ] 



at Pisa, as having discovered the circulation during the pcnod from 1671-1593 prior 
to Harvey (1616) Cesalpmo described the lessor circulation, but his observations did 
not lead him to a clear recognition of the greater circulation Ccsalplno is deserving 
of credit, however, and it is possible that Harvey know of his work while he was a 
student at Padua In his first chapter of “Do motu cordis,’’ Harvey suggests that 
he sought to discover the motions and uses of the heart “from actual inspection 
and not from the writings of others ” Por this purpose ho resorted to vivisection, 
ligation and perfusion He experimented on several living animals whose hearts 
were observable with the naked eye, and also on some smaller animals whoso hearts 
he could observe with the aid of a magnifying glass As an anatomist, and an out- 
standing one, he was further able to confirm much of his proof of the circulation on 
the basis of his many dissections of human bodies 

The mainstay of Harvey’s argument — that the actual quantity of blood as 
measured made it physically impossible for the blood to do other than return to 
the heart by the venous route — not only gave him definite proof of the circulation but 
also, as Garrison (p 247) has so well stated, insured that his computation was the 
first idea of measurement m any biologic investigation This quantitative demonstra- 
tion gave impetus to the rise of physiology 

After the publication of “De motu cordis,” there can be no doubt that Harvey’s 
prestige as a phsrsiclan suffered somewhat He was severely attacked by the pedantic 
thinkers of the time But this disturbance was more than counterbalanced by the 
acceptance during his lifetime of his most important contribution 

Harvey, at an early date (1613), had been elected to the oilicc of censor in the 
College of Physicians He was reappomted to tins ofiicc in 1625 and again in 1629 
In 1628 he was appointed Treasurer of the “College,” to which office ho was reap 
pointed in 1629 In the same year he received the commands of the King to accom 
pany the Duke of Lennox, who was sent to travel abroad Ho continued to travel 
with the Duke until the winter of 1631-1632, at which time ho returned to England 
In 1632 he drew up a set of rules for the new library of the College of Physicians 
Early in 1633, Harvey again received the commands of the King, this time to attend 
Charles I on his journey to Scotland During this trip he wrote his treatise on the 
‘ ‘Bass Hock ’ ’ 

In 1634, the story of the Lancashire witches ran rampant through England As 
was the case in the Salem witchcraft episode in New England in 1692, the accusations 
were the result of a child’s perjury Dr Harvey was called upon to examine the 
bodies of some of the arrested “witches” and some of those permitted to live 
Owing to his testimony and that of others, four of the seven convicted “witches” 
were pardoned Harvey’s attitude is all the more remarkable, considenng that his 
contemporary in medicine. Sir Thomas Browne (1605-1682), supposedly a model of 
tolerance, affirmed that he believed in witchcraft (Smith, vol 1, p 445), and the 
great Carl Linnaeus (1707-1778), born 129 years later than Harvey, displayed in his 
“Nemesis Divina,” written for his son, that he believed in supernatural punishments 
(Smith, vol 2, pp 540, 541) 

Another interestmg experience occurred to Harvey m 1635 In this year he was 
ordered by the King to perform necropsy on the body of Thomas Parr, who is said to 
have died at the ripe age of one hundred and fifty-two years and nine months The 
notes of this necropsy were not printed until 1669, when they were published in 
Bett’s “On the Source and Quality of Blood ” From these notes it appears that 
Harvey believed “Old Tom Parr” would have lived even longer had he remained 
in his native home, Shropshire, and not transported himself to London and altered 
his diet by living with a nobleman' 

Harvey’s friendship with the King resulted in his bemg suspected, and rightly, of 
being an enthusiastic Loyalist In the early part of the Civil War (1642), a mob 

[16] 



of citizen-soldiers entered Harvey’s lodgings, stole his goods, and scattered his papers 
These papers included the records of a large number of dissections, his observations 
on the development of insects, and a series of notes on comparative anatomy 

In 1645 Harvey was elected to the honorable position of warden of Merton College 
at the University of Oxford This was the school of which the famous John of 
Gaddesden (circa 1350), one of the earliest Englishmen to write a complete treatise 
on medicine,2 had been a fellow Because of the tumult of the Cromwellian Civil 
War, Harvey held this position for only one year 

The surrender of Oxford in 1645 marks the penod of Harvey’s severance from 
the Court and his gradual retirement from public life, occasioned in part by his being 
affected with gout, from which he suffered recurrent attacks Dunng this time he 
was preparing his essay “De generatione animalium,” which was published in 1651 
In his investigation of the embryo, handicapped as he was by not havmg a micro- 
scope, he formed a wrong idea of fecundation He believed the fertilization of the 
ovum to be somethmg ‘ ‘incorporeal — as iron touched by the magnet is endowed with 
its own powers” Gamson (p 248) suggests that the true importance of ‘‘De 
generatione” was ‘‘that it subverted the ancient concept that life is engendered out 
of corruption (or putrefaction) ” 

The College of Physicians was promised, by an anonymous donor, a library of 
books, a museum of numerous objects of curiosity, and a variety of surgical instru- 
ments Before the buildmg was completed the name of the generous benefactor be- 
came known, and the College responded in 1652 by creating a statue of Harvey 
But the College still felt indebted to Harvey and chose him as its president m 
1654 He, however, did not accept this honor, recognizing the influences of the in- 
firmities in his health The attacks of gout continued, and he died on June 3, 1657, 
from a cerebral hemorrhage He was buned in the family vault at Hempstead in 
Essex 

Abraham Cowley (1618-1667) wrote of Harvey 

‘ ‘Harvey sought for Truth, m Truth’s own book. 

The creatures, which by God himself was wnt. 

And wisely thought ’twas fit. 

Not to read comments only upon it. 

But on th’ original itself to look ’ ’ 


sRosa AnffUca, printed m 1492 


[ 17 ] 



SXERCITJTIO 

ANATOMICA DE 

MOTV cordis ET SAN- 

GVINIS IN ANIMALI- 

BVS, 


qVILIELMI HARVEI ANCLI, 
Media Regti , 0" Erofeforis eAnatomm m Col- 

Ugto iMedicontm Londmenji. 



T RANC OFFRT ly 

Sumptibus GVILIELMI FITZERI. 


XNNO M DC. XX nil. 


AN ANATOMICAL DISQUISITION ON THE 
MOTION OF THE HEART AND BLOOD 
IN ANIMALS'^ 

By 

WILLIAM HARVEY, M.D. 
INTMODUCTION 

A S WE are about to discuss the motion, action, and use of the heait and 
arteries, it is imperative on us first to state what has been thought of 
these things by otheis in their writings, and what has been held by the 
vulgar and by tradition, in older that what is tiue may be confiimed, and 
what is false set light by dissection, multiplied experience, and accurate 
obseivation 

Almost all anatomists, physicians, and philosophers, up to the present 
time, have supposed with Galen, that the object of the pulse was the same 
as that of lespiration, and only differed in one particular, this being con- 
ceived to depend on the animal, the respiration on the vital faculty, the 
two, in all othei respects, whether with reference to purpose or to motion, 
comporting themselves alike Whence it is affirmed, as by Hieronymus 
Pabricius of Aquapendente, in his book on “Respiration,'’ rvliich has lately 
appeared, that as the pulsation of the heart and arteries does not suffice 
for the ventilation and refrigeration of the blood, therefore were the lungs 
fashioned to surround the heart Prom this it appears, that whatever has 
hitherto been said upon the systole and diastole, on the motion of the heart 
and arteries, has been said with especial leference to the lungs 
But as the stiuctuie and movements of the heart differ from those of 
the lungs, and the motions of the arteries from those of the chest, so seems 
it likely that the other ends and offices rvill thence arise, and that the pulsa- 
tions and uses of the heart, likewise of the arteries, will differ in many 
respects from the heavings and uses of the chest and lungs Poi did the 
arterial pulse and the lespiiation seive the same ends, did the arteries 
in their diastole take an into then cavities, as eommonlv stated, and in 
their systole emit fuliginous vapours by the same pores of the flesli and 
skin, and further, did they, in the time intermediate between the diastole 
and the systole, contain air, and at all times eithei air, or spirits, oi fuligi- 
nous vapours, what should then be said to Galen, vho mote a book on 
purpose to show that by nature the arteries contained blood, and notlnng 

*Excicifntio anatomica de moin coidis et sanijuinis tn animahbiis, London 1C2S Tnn=- 
lated Robcjt IVillis, B-vrncs Surrei, England. 1817 

[ 19 ] 



but blood, neither spnits noi an, consequently, as may be readily gathered 
from the expeiiments and leasonings contained in the same book? Now 
if the aiteiies aie filled in tlie diastole with an then taken into them (a 
larger quantity of an penetiating when the pulse is huge and full), it 
must come to pass, that if you plunge into a bath of walei oi of oil when 
the pulse is stiong and full, it ought ioitlnnth to become either smallei or 
much slowed, since the cncumambieiit bath will icndei it either difficult 
or impossible foi the an to penetiatc In like mainiei, as all the aiteiies, 
those that aie deep-seated as w'ell as those that aic supeificial, aie dilated 
at the same instant, and wuth the same iapidil\, how wcie it possible that 
air should penetiatc to the deepei paits as fiech and quicklj thiough the 
skin, flesh, and othei stiucluios, as thiough the meie cuticle? And how 
should the aiteiies of the foetus diaw' an into then cavities thiough the 
abdomen of the mothci and the bodw of the womb? And how should 
seals, whales, dolphins and othei cetaceans, and fishes of evei^ dcsciiption, 
living in the depths of the sea, take in and emit an bv the diastole and 
systole of then aiteiies thiough the infinite mass of watcis? Foi to saj 
that they absorb the an that is infixed in the watci, and emit then fumes 
into this medium, weie to uttci something vciv liKc a mcie figment And 
if the aiteiies in then systole expel fuliginous vapouis fiom then cavities 
through the poies of the flesh and skin, wh’\ not the spnits, which aic said 
to be contained in these v'essels, at the same time, since spnits aie much 
moie subtile than fuliginous vapouis oi smoke'? And fnilhei, if the 
aiteries take in and cast out an in the sv stole and diastole, like the lungs 
in the piocess of lespnation, wheiofoie do thev not do the same thing when 
a wound is made in one of them, as is done in the opciation of aiteiiotomy’ 
When the windpipe is divided, it is sufficicnth obvious that the an enteis 
and 1 etui ns thiough the wound bv two opposite movements, but when 
an aiteiy is divided, it is equallv manifest that blood escapes in one con- 
tinuous stieam, and that no an eithei enteis oi issues If the pulsations 
of the aiteiies fan and lefiigeiate the seveial paits of the bodv' as the 
lungs do the heait, how comes it, as is commonlv said, that the aiteiies 
eaiiy the vital blood into the diffeient paits, abundanth chaigcd with 
vital spnits, which cheiish the heat of these paits, sustain them when 
asleep, and leeiuit them when exhausted^ And how should it happen 
that, if you tie the aiteiies, immediately the paits not only become toipid 
and frigid, and look pale, but at length cease even to be nouiished? This, 
according to Galen, is because they aie depiived of the heat which flowed 
through all parts fiom the heait, as its souice, whence it wmuld appeal 
that the aiteries rathei cany waimth to the paits than scive foi anv' 
fanning or refrigeiation Besides, how can the diastole (of the aiteiies) 
draw spnits from the heait to waim the body and its paits, and, fiom with- 
out, means of cooling oi tempeiing them? Still fuithei, although some 
affirm that the lungs, aiteiies, and heait have all the same offices, they yet 
maintain that the heart is the workshop of the spnits, and that the aiteries 


[ 20 ] 



eontaiu and tiansnnt them, denymg, howevei, m opposition to the opinion 
of Columbus, that the lungs can eithei make or contain spiiits, and then 
they asseit, with Galen, against Eiasistratus, that it is blood, not spirits, 
which IS contamed in the arteries 

These various opinions are seen to be so incongiuous and mutually 
subversive, that every one of them is not unjustly brought under suspicion 
That it IS blood and blood alone which is contained in the aiteries is made 
manifest by the expeiiment of Galen, by arteriotomy, and by wounds, 
for from a single artery divided, as Galen himself affiims in moie than 
one place, the whole of the blood may be withdrawn in the course of half 
an houi, or less The expeiiment of Galen alluded to is this “If you in- 
clude a poition of an aiteiy between two ligatures, and slit it open length- 
waj’-s, you will find nothing but blood”, and thus he proves that the 
arteiies contain blood only And we too may be peimitted to pioceed by a 
like tram of leasomng if we find the same blood in the aiteiies that we 
find in the vems, which we have tied in the same way, as I have myself re- 
peatedly ascei tamed, both m the dead body and m living animals, we may 
fairly conclude that the aiteiies contain the same blood as the vems, and 
nothing but the same blood Some, whilst they attempt to lessen the diffi- 
culty here, affirming that the blood is spiritous and ai tenons, virtually con- 
cede that the office of the aiteiies is to carry blood fiom the heart mto 
the whole of the body, and that they aie therefoie filled with blood, foi 
spiritous blood is not the less blood on that account And then no one 
denies that the blood as such, even the poition of it which fiows m the 
vems, IS imbued with spirits But if that poition which is contained m the 
aiteiies be richer m spiiits, it is still to be believed that these spirits are 
inseparable from the blood, like those m the vems, that the blood and 
spirits constitute one body (like whey and butter m milk, or heat [and 
water] m hot watei), with which the arteiies are chaiged, and for the 
distribution of which fiom the lieait thej'' aie piovided, and that this body 
IS nothing else than blood But if this blood be said to be diavm from the 
lieait mto the aiteiies by the diastole of these vessels, it is then assumed 
that the aiteiies by then distension aie filled ivith lilood, and not witli the 
ambient air, as heretofoie, foi if they be said also to become filled with 
an fiom the ambient atmosphere, how and when, I ask, can thej^ leceive 
blood fiom the heait^ If it be answered dining the systole, I saj’’, that 
seems impossible, the arteiies would then have to fill whilst they con ti acted, 
m other woids, to fill, and yet not become distended But if it be said 
dining the diastole, they would then, and foi two opposite pin poses, be 
leceivmg both blood and an, and heat and cold, which is impiobable 
Pinther, when it is affiimed that the diastole of the heait and aiteries is 
simultaneous, and the sj^^stole of the tno is also coneuiient, theie is anotliei 
mcongiuity For how can two bodies mutually connected, wlneli aie simul- 
taneousty distended, attiact oi diaw aiivthmg fiom one anothei , oi, being 
simultaneously conti acted, leceive anything fiom each othei ’ And tlien 

[ 21 ] 



it seems impossible that one body can llins alliacl .niolliei body into ilscli, 
so as to become distended, seeing that lo be distended is to be passu c, unless, 
111 the mannei of a sponge, pieyionslj^ compicssed by an cvleinal foice, 
whilst it IS letiiining to its natnial state But it is difficult to conceiyc 
that theie can be anything of this kind in the aitciies The aitciics 
dilate, because they aic filled like bladdeis oi leathcin bottles, they 
aie not filled because they expand like belloys This I think easy of 
demonsti ation , and indeed conceiye that I haie all cad j pioicd it 
Neveitheless, in that book of Galen headed 'Quod Sanguis continetui in 
Aiteiiis,’ he quotes an expciimeiit to pioie tlic contiaiv An aitciy 
haying been exposed, is opened longitudinally, and a iced oi othei 
peivious tube, bj’’ which the blood is pieycnted fiom being lost, and the 
wound IS closed, is nisei ted into the ycssel thiough the opening “So 
long,” he says, “as things aie thus aiianged, the yhole aiteiy uill 
pulsate, but if jmu now thiow a ligaluic about the yessel and tightlj com- 
piess its tunics ovei the tube, jou a\i11 no longci see the ailciy beating 
beyond the ligatuie ” I haye ncAci peifoimcd this cxpciiment of 
Galen’s, noi do I think that it could Aeiy yell be peifoimcd in the Ining 
body, on account of the piofuse flow of blood that y ould take place fiom 
the Amssel which was opciatcd on, neithei yould the tube cftcctualh 
close the wound in the \esscl y ithout a hgatuie, and I cannot doubt but 
that the blood would be found to floy out betyeen the tube and the 
yessel Still Galen appeals by this expeiimcnt to plo^e botli that the 
pulsative faculty extends fiom tlie lieait by the y .ills of the aitciics, and 
that the aiteiies, ydiilst they dilate, aie filled b> that pulsific foico, he- 
eatise they expand like bellows, and do not dilate because they aie filled 
like skins But the contiaiy is obyious in ai tenotomy and ni y ounds , foi 
the blood spin ting fiom the aiteiies esc.npes with foice, noy f.iithei, iioy 
not so fai, alternately, oi in jets, and the jet alwa^s takes place yith 
the diastole of the aiteiy, nevei Avith the systole By yliich it cleaily 
appeals that the aiteiy is dilated by the impulse of the blood , foi of itself 
It would not thiow the blood to such a distance, and yhilst it yas dilat- 
ing, It ought lathei to diaiy an into its cavity thiough the y ound, weie 
those things tiue that aie commonly stated conceiiiing the uses of the 
aiteiies Nor let the thickness of the aiteiial tunics impose upon us, and 
lead us to conclude that the pulsative piopeity piocceds along them fiom 
the heait Foi in seveial animals the aiteiies do not appaiently diftei 
fiom the veins, and in extieme paits of the body, yheie the aiteiies aic 
minutely subdivided, as in the biain, the hand, etc, no one could dis- 
tinguish the aiteiies fioin the veins by the dissmiilai chaiacteis of then 
coats, the tunics of both aie identical And then, in an aneuiisni pio- 
ceednig fiom a wounded oi eioded aiteiy, the pulsation is piecisely 
the same as in the other aiteiies, and yet it has no piopei aiteiial tunic 
This the learned Riolanus testifies to, along with me, in his Seventh 
Book 


[ 22 ] 



Nor let an> one imagine that the uses of the pulse and the lespiration 
are the same, because under the influence of the same causes, such as 
lunning, angei, the waim bath, or anj'- other heating thing, as Galen says, 
they become moie fiequent and forcible togethei Foi, not only is ex- 
peiienee in opposition to this idea, though Galen endeavois to explain it 
away, when we see that with excessive lepletion the pulse beats moie 
foicibly, whilst the lespiiation is diminished in amount, but in young 
pel sons the pulse is quick, while respiiation is slow So also is it in 
alarm, and amidst caie, and under anxiety of mind, sometimes, too, in 
fevers, the pulse is lapid, but the lespiiation is slowei than usual 

These and othei ob;]ections of the same kind may be urged against the 
opinions mentioned Nor are the views that aie entertained of the offices 
and pulse of the heait, perhaps, less bound up with gieat and most inex- 
tiicable difficulties The heait, it is vulgaily said, is the fountain and 
woikshop of the vital spirits, the centie fiom whence life is dispensed to 
the several paits of the body, and jmt it is denied that the light ventricle 
makes spiiits, it is rather held to supply nouiishment to the lungs, 
whence it is maintained that fishes are without any right ventiicle (and 
indeed every animal wants a light ventiicle which is unfuinished with 
lungs), and that the right ventricle is piesent solely foi the sake of the 
lungs 

1 Why, I ask, when we see that the structuie of both ventiicles is 
almost identical, there being the same appaiatus of fibies, and biaees, 
and valves, and vessels, and auricles, and in both the same infarction of 
blood, in the subjects of oiii dissections, of the like black colour, and 
coagulated — why, I say, should then uses be imagined to be diffieient, 
when the action, motion, and pulse of both aie the same'^ If the thiee 
tricuspid valves placed at the entiance into the right ventiicle piove 
obstacles to the leflux of blood into the vena cava, and if the thiee 
semilunai valves, which are situated at the commencement of the pul- 
monaiy arteiy be theie, that they may prevent the return of blood into 
the ventiicle, wheiefoie, when we find similai stiuctuies in connexion 
with the left ventricle, should we deny that they are theie for tlie same 
end, of pi eventing here the egiess, there the reguigitation of the blood? 

2 And again, when we see that these stiuctuies, in point of size, form, 
and situation, aie almost in eveiy lesjiect the same in the left as in the 
light ventiicle, wheiefoie should it be maintained that things aie heie 
airanged in connexion with the egiess and legrcss of spiiits, theie, i e, 
in the light, of blood The same aiiangement cannot be held fitted to 
favoi 01 impede the motion of blood and of spiiits indiff ei ently 

3 And when we obseive that the passages and vessels aie seieiallv 
in 1 elation to one anothei in point of size, mz, the piilmonaiy aiteiy 
to the pulmonaiy veins, wheiefoie should the one be imagined destined 
to a piivate oi paiticulai pm pose, that to wit, of nomishing the lungs the 
other to a public and geneial function'’ 

[ 23 ] 



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vapours when we divide the arteria venosa'? Why do we always find 
this vessel full of sluggish blood, never of an Whilst in the lungs we 
find abundance of air remaining 

If any one will perform Galen's expeiiment of dividing the trachea of 
a living dog, forcibly distending the lungs with a pair of bellows, and 
then tying the trachea securely, he will find, when he has laid open the 
thoiax, abundance of air in the lungs, even to their extreme investing 
tunic, but none in either pulmonary veins, or left ventricle of the heart 
But did the heart either attract air fiom the lungs, or did the lungs 
transmit any air to the heart, in the living dog, by so much the moie 
ought this to be the ease in the experiment 3ust referred to Who, indeed, 
doubts that, did he inflate the lungs of a sub3ect in the dissecting-room, 
he would instantly see the air making its way by this route, were there 
actually any such passage for if? But this office of the pulmonary veins, 
namely, the transference of air from the lungs to the heart, is held of 
such importance, that Hieronymus Fabrieius, of Aquapendente, maintains 
the lungs were made for the sake of this vessel, and that it constitutes 
the principal element in their structure 
But I should like to be informed wherefore, if the pulmonary vein 
were destined for the conveyance of air, it has the structure of a blood- 
vessel here Nature had rather need of annular tubes, such as those of the 
bronchia, in order that they might always remain open, not have been 
liable to collapse , and that they might continue entirely free from blood, 
lest the liquid should interfere with the passage of the air, as it so ob- 
viously does when the lungs labour from being either greatly oppressed 
or loaded in a less degree with phlegm, as they are when the breathing is 
performed with a sibilous or rattling noise 
Still less IS that opinion to be tolerated which (as a two-fold mattei, 
one aereal, one sanguineous, is requiied for the composition of vital 
spirits) supposes the blood to ooze through the septum of the heart 
fiom the right to the left ventricle by certain secret pores, and the an 
to be attracted from the lungs through the great vessel, the pulmonary 
vein , and which will have it consequently, that there are numerous pores 
in the septum cordis adapted for the transmission of the blood But, in 
faith, no such pores can be demonstrated, neither in fact do any such 
exist For the septum of the heait is of a denser and moie compact struc- 
ture than any portion of the body, except the bones and sinews But 
even supposing that theie were foramina or pores in this situation, how 
could one of the ventiicles extiact anything fiom the other — ^the left, 
eg, obtain blood fiom the right, when we see that both ventricles eon- 
tiact and dilate simultaneously? Wherefoie should we not rather believe 
that the light took spirits from the left, than that the left obtained 
blood fiom the light ventricle, through these foramina? But it is 
ceitainly mysterious and incongruous that blood should be supposed to 
be most eommodiously drawn thiough a set of obscure or invisible pores, 

[ 25 ] 



and an through peifectly open passages, at one and the same moment 
And why, I ask, is lecouise had to sceict and invisible poiosities, to un- 
eeitain and obscme channels, to cvp^*''^' l-hc passage o£ the blood into the 
left ventiiele, Avhen theic is so open a w.i}’' tlnough the jnilmonaiy Aeins*? 
I own it has always appealed e\tiaoidinan to me tliat thej should ha^c 
chosen to make, oi lathei to imagine, a nay tlnough the thiek, haul, 
and extieinely compact substance of the sejitum coidis, lathei than to 
take that by the open las ■\enosum oi jmlmonan ^eln, oi cAcn tlnough 
the lax, soft and spongj’’ substance of the lungs at huge Besides, if the 
blood could peimeate the .substance oi the se])tiini, oi could be imbibed 
from the sentiielcs, what use wcic theie fo\ the eoumaw aitevs and sc\n, 
blanches of nhieh piocced to the sciilum ilscH, to siippls it nith nouiish- 
ment^ And nhat is espcciallv noilln ol notice is tins if in the foetus, 
wheie eveiything is moic lax and soft, natuie saw hciself i educed to the 
necessity of bunging the blood fiom the light into the left side of the heait 
by the foramen ovale, fiom the \ena ca\a tlnough the aiteiia ^enosa, how 
should it be likely that in the adult she should pass it so coinmodioush, 
and wathoiit an effort, tlnough the septum Acntneiiloi uin, which has now 
become densei by age^ 

Andieas Lauientius,’ icsting on the authoiit\ of Galen- <ind the cxpcii- 
enee of Holleiius, asseits and pio\os that the seium and pus in empAema, 
absoibed fiom the cavities of the chest into the juilmonan ■Noin, maj be ex- 
pelled and got lid of with the uiine and facees tlnough the left ^entllclo 
of the heait and aiteiies He quotes the case oi .i ceitain poison aflcctcd 
with melancholia, and w’ho suffciod fiom icpeatcd iaintnur fits who was 
lelieved fiom the paioxjsms on passing a ciuantitv of tin bid, fetid, and 
aciid uiine, but he died at last, worn out bi the dise.ise, and when the 
body came to be opened aftei death, no fluid like that he had mictuiated 
wms discoveied eithei in the bladdei oi in the kidneis, but in the left 
ventiicle of the heait and cavitA’’ of the thoiax plentv of it was met with, 
and then Lauientius boasts that he had piedictcd the cause of the sjmiptoms 
Foi my owui pait, how’^evei, I cannot but wondei, since he had divined and 
piedicted that heteiogenous mattei could be dischaiged bv the com so he 
indicates, ivliy he could not oi wmuld not peiceive, and infoim us that, in 
the natuial state of things, the blood might be eommodioush tiansfciiod 
from the lungs to the left ventiicle of the heait hi’^ the veiy same loiite 

Since, theiefoie, fiom the foiegoing considoi ations and maiij’" otheis to 
the same effect, it is plain that ivhat has heictofoie been said eoiieeining 
the motion and function of the lieail and aiteiies must appeal obscuie, 
01 inconsistent oi even impossible to him who eaiefiilly consideis the 
entile subject, it will be propei to look moie naiiowdj'- into tiie mattei, 
to contemplate the motion of the heart and aiteiies, not only in man, but 

mib lx, cap xz Quest 12 

=De Locis Affectis lib vi cap 7 

[26] 



in all animals that have heaits, and further, by fiequent appeals to vivisec- 
tion, and constant ocular inspection, to investigate and endeavor to find 
the tiuth 

CHAPTER I 

THE AUTHOR’S MOTIVES FOR WRITING 

When I first gave my mind to vivisections, as a means of discovering 
the motions and uses of the heart, and sought to discover these from actual 
inspection, and not fiom the iviitings of otheis, I found the task so truly 
aiduous, so full of difficulties, that I was almost tempted to think, with 
Fraeastoiius, that the motion of the lieait was only to be comprehended 
by God Foi I could neither rightly peiceive at first when the systole and 
when the diastole took place, nor when and where dilatation and contrac- 
tion occuired, by reason of the lapidity of the motion, which in many 
animals is accomplished m the twinkling of an eye, coming and going like 
a flash of lightning, so that the systole piesented itself to me now from 
this point, now fiom that , the diastole the same , and then eveiy thing was 
reversed, the motions occurring, as it seemed, variously and confusedly 
together My mind was theiefoie greatly unsettled, nor did I know what 
I should myself conclude, nor what believe from others, I was not sur- 
piised that Andreas Laurentius should have said that the motion of the 
heait was as peiplexmg as the flux and reflux of Euripus had appealed 
to Aiistotle 

At length, and by using gieatei and daily diligence, having frequent 
recourse to vivisections, employing a vaiiety of animals for the purpose, 
and collating numeious observations, I thought that I had attained to the 
truth, that I should extiicate myself and escape from this labyrinth, aUd 
that I had discoveied what I so much desired, both the motion and the use 
of the heart and aiteiies, since which time I have not hesitated to expose 
my views upon these subjects, not only in piivate to my fi lends, but also 
m public, in my anatomical lectures, after the mannei of the Academy of 
old 

These views, as usual, pleased some moie, otheis less, some chid and 
calumniated me, and laid it to me as a ciime that I had daied to depart 
fiom the piecepts and opinion of all anatomists, otheis desired further ex- 
planations of the novelties, which they said weie both woithy of considera- 
tion, and might perchance be found of signal use At length, yielding to 
the lequests of my fiiends, that all might be made participators in my 
laboius, and partly moved by the envy of others, ivlio, leceiving my vievs 
with uncaiidid minds and understanding them indiffeiently, lia^e essayed 
to tiaduce me publicly, I have been moved to commit these things to the 
press, 111 order that all may be enabled to foim an opinion both of me and 
my iabouis Tins step I take all the more villingly, seeing that Hieionjunus 
Fabiicius of Aquapendeiite, although he has accuiatety and learnedly 

[ 27 ] 



delineated almost e\eiy one ol llie seieial pails of animals in a special 
Moik, lias left tlie Iieait alone nnlouclicd I'^nallv, if any use or benefit 
to tins depaitment of the republic of lettcis slioiikl .iceiue fiom my laboiiis, 
It will, peiliaps, be allowed that I have not Incd idly, and, as the old man 
in the coined}’" says 

For novel yet liatli nnj one ittiuneil 
To such perfection, but tli it iniie, and place, 

And use, lia\o brought idditiou to his hnon ledge. 

Or made collection, or admonished him, 

That he vas ignorant of much which ho 
Had thought he hnew , or led him to rcicct 
"What he h id once esteemed of highest price 

So Will it, pel chance, be found nilh lelcieiicc to the lieait at this time, oi 
others, at least, staiting fiom hence, the i\a\ pointed out to tliem, ad- 
vancing nndei the guidance of a happici genius, ma\ make occasion to 
pioeeed moie fortunately, and to inquiic moic acciiiatcl} 


CHAPTER II 


OF THE il/0770iYiS' OF THE HEART, AS SEEN IN THE 


DISSECTION OF L/]^7iYC? ANIMALS 


In the fiist place, then, when the chest of a liiing animal is hud open 
and the capsule that immediatch siuiounds the hcait is slit up or ieino\cd, 
the organ is seen now to move, non to he at lest, — thcie is a lime nhen it 
moves, and a time nheu it is motionless 

These things aie moie obvious m the coldei animals, such as toads, 
flogs, serpents, small fishes, crabs, shiimps, snails and shell-fish Thc^ 
also become moie distinct in waim-bloodcd animals, such as the dog and 
the hog, if they be attentively noted when the heait begins to flag, to 
move moie slowly, and, as it weie, to die the moicments then become 
slowei and laier, the pauses longer, by Avhieh it is made much moie easy 
to peiceive and unravel what the motions leally aie, and hon they aie 
peifoimed In the pause, as in dealh, the heait is soil, flaccid, exhausted, 
lying, as it weie, at rest 

In the motion, and interval in which tins is accomplished, thiee pini- 
cipal ciienmstances aie to be noted 

1 That the heart is elected, and uses npwaid to a point, so that at 
this time It strikes against the hi east and the pulse is felt externally 

2 That it IS eveiywheie contiaeted, but moie especially towards the 
sides, so that it looks nanowei, i datively longer, more diawn togetliei 
The heait of an eel taken out of the body of the animal and placed upon 
the table oi the hand, shows these paiticnlais, but the same things aie 
manifest in the heait of small fishes and of those colder animals wheie 
the organ is more conical or elongated 

[281 



3 The heart being giasped in the hand, is felt to become haidei during 
its action Now this haidness proceeds fiom tension, piecisely as when 
the foreaini is giasped, its tendons are perceived to become tense and 
resilient when the fingers are moved 

4 It may fiiithei be observed in fishes, and the colder blooded animals, 
such as frogs, serpents, etc , that the heart, when it moves, becomes of a 
paler colour, when quiescent of a deeper blood-ied colour 

From these particulars it appeared evident to me that the motion of the 
heart consists in a certain umveisal tension — both contraction in the line 
of its fibres, and constriction in every sense It becomes erect, hard, and 
of diminished size during its action, the motion is plainly of the same 
nature as that of the muscles when they contract in the line of their 
sinews and fibres, for the muscles, when in action, acquire vigour and 
tenseness, and from soft become hard, prominent and thickened in the 
same manner the heart 

We are therefore authorized to conclude that the heart, at the moment 
of its action, is at once constricted on all sides, rendered thicker in its 
parietes and smaller in its ventricles, and so made apt to project or expel 
its charge of blood This, indeed, is made sufficiently manifest by the 
fourth obseivation piecedmg in which we have seen that the heart, by 
squeezing out the blood it contains becomes paler, and then when it 
sinks into lepose and the ventricle is filled anew with blood, that the 
deeper crimson colour returns But no one need remain in doubt of the 
fact, for if the ventricle be pieiced the blood will be seen to be forcibly 
projected outwards upon each motion or pulsation when the heart is 
tense 

These things, therefore, happen together or at the same instant the 
tension of the heart, the pulse of its apex, which is felt externally by its 
striking against the chest, the thickening of its parietes, and the forcible 
expulsion of the blood it contains by the constriction of its ventricles 

Hence the very opposite of the opinions commonly received, appears 
to be true, inasmuch as it is generally believed that when the heart 
strikes the breast and the pulse is felt without, the heart is dilated in its 
ventricles and is filled with blood, but the contrary of this is the fact, 
and the heart, when it contracts [and the shock is given], is emptied 
Whence the motion which is generally regarded as the diastole of the 
heart, is in truth its systole And in like mannei the intrinsic motion 
of the heart is not the diastole but the systole, neither is it in the di- 
astole that the heart grows firm and tense, but in the systole, for then 
only, when tense, is it moved and made vigorous 

Neither is it by any means to be allowed that the heart only moves in 
the line of its straight fibres, although the great Vesalius, giving this 
notion countenance, quotes a bundle of osiers bound into a pyramidal 
heap m illustration, meaning, that as the apex is approached to the base, 
so are the sides made to bulge out m the fashion of arches, the cavities to 

[ 29 ] 



dilate, the A^entiieles to aequue the foiin of <i cniiping-gLiss and so to 
suck in the blood But the tiue elfeet ol cvciy one of its hbies is to coii- 
stiinge the heait at the same time that they leiidci it tense, and this 
lathei Avith the effect of thickening and amplifying the Mails and sub- 
stance of the oigaii than cnlaiging its leiitiielcs And, again, as tJic 
fibies lun fioin the apex to the base, and di.iu the apex toivaids the 
base, they do not tend to make the Avails of the hcait bulge out in cnclcs, 
but lathei the contiaiy, nmsmueh .is cAciy fibie that is cnculaily dis- 
posed tends to become sliaight uhon it coiili.ufs, and is dislonded latei- 
ally'- and thickened, as in the c.ise of musciilai fibics in gcncial, vheii they 
contiact, that is Avhen they aie sJioitencd longiludin.illy , as mc see them 
in the bellies of the muscles of the boch .it laigc 'Po .ill tins let it be 
added th.at not oiih aie the \enliicles eoiiti.uted in Aiitno oi the dnee- 
tion and condensation of then walls, but f.nthei, that those fibics, oi 
bands, styled nenes by' Aiistotle, A\hich aie so conspuuous in the Acn- 
tiicles of the laigei annuals, and contain all the sli.nght hbcis (the 
paiietes of the heait conlaining onh ciuulai ones ) when thoA conti.net 
simultaneously, by an adnmable ad.iustment all the inteinal suifaces aic 
diaAvn togethei, as if A\ith coids, .ind so is the ch.nge of blood expelled 
Avith foice 

Neithei is it true, as Aulgaih belieAcd, that the heait Iia am dilatation 
01 motion of its OAvn, has the poAsei of diaAiing the blood into the acii- 
trieles, foi Avhen it acts and becomes tense, the blood is expelled, A\hen it 
lelaxes and sinks togethei it iccenes the blood in the mannei and a\isc 
Avhich Avill by and by be explained 

CHAPTER III 

OF THE MOTIONS OF ARTERIES, AS SEEN IN THE 
DISSECTION OF LIVING ANIMALS 

In connexion Avith the motions of the heait these things aie fuithei 
to be obseiAmd liaAung lefeience to the motions and pulses of the aiteiies 

1 At the moment the heait contiacts, and Avhen the bieast is stiuck, 
Avhen in shoit the oigan is in its state of sy'-stole, the ai tones aie dilated, 
yield a pulse, and aie in the state of diastole In like mannei, A\hen the 
light ventiiele contiacts and piopels its chaige of blood, the aiteiial 
vein [the pulmonaiy aiteiy^] is distended at tlie same time Avith the othei 
aiteiies of the body 

2 When the left Amntiicle ceases to act, to contiact, to pulsate, the 
pulse in the aiteiies also ceases, fuithei, Avhen this Amntiicle contiacts 
languidly, the pulse in the aiteiies is scaicely’’ peiceptible In like nian- 
nei, the pulse in the light ventiiele failing, the pulse in the a eiia aiteiiosa 
[pulmonaiy arteiy] ceases also 


[^ 0 ] 



3 Further, when an aitery is divided or punctured, the blood is seen 
to be foicibly propelled fiom the wound at the moment the left A^entricle 
contracts, and, again, when the pulmonary aiteiy is wounded, the blood 
Avill be seen spouting foith ivith Auolence at the instant when the light 
ventiicle contracts 

So also in fishes, if the A^'essel which leads from the heart to the gills 
be dmded, at the moment when the heart becomes tense and contracted, 
at the same moment does the blood flow with force fiom the dmded ves- 
sel 

In the same way, finally, Avhen we see the blood in ai tenotomy pro- 
jected noAv to a gieatei, now to a less distance, and that the greater jet 
corresponds to the diastole of the aitery and to the time ivhen the heart 
contiacts and strikes the ribs, and is in its state of systole, we understand 
that the blood is expelled by the same niOA^ement 

From these facts, it is manifest, in opposition to commonly lecen^ed 
opinions, that the diastole of the aiteries coriesponds with the time of 
the heart’s systole, and that the aiteries aie filled and distended by the 
blood forced into them by the conti action of the A^entricles, the aiteiies, 
therefore, are distended, because they are filled like sacs or bladders, and 
are not filled because they expand like bellows It is in Auitue of one and 
the same cause, theiefoie, that all the arteries of the body pulsate, viz, 
the contraction of the left ventiicle, in the same way as the pulmonary 
arteiy pulsates by the conti action of the light ventiicle 

Finally, that the pulses of the aiteries aie due to the impulses of the 
blood from the left ventricle, may be illustrated by blowing into a glove, 
when the ivhole of the fingeis will be found to become distended at one 
and the same time, and in then tension to beai some lesemblance to the 
pulse Foi in the ratio of the tension is the pulse of the heart, fuller, 
stionger, moie fiequent as that acts more Augoiously, still preserving 
the ihythm and volume, and ordei of the heart’s contractions Nor is 
it to be expected that because of the motion of the blood, the time at 
which the contraction of the lieait takes place, and that at Avhich the pulse 
in an arteiy (especially a distant one) is felt, shall be otheiwise than 
simultaneous it is heie the same as in blowing up a gloAi-e or bladder, 
for in a plenum (as in a dium, a long piece of timbei, etc ) the stroke 
and the motion occui at both extiemities at the same time Aiistotle,^ 
too, has said, “the blood of all animals palpitates Avithm their ^'enis 
(meaning the aiteiies), and by the pulse is sent eA^eiyivlieie simultane- 
ously ” And fuither,^ “thus do all the I'-eins pulsate togethei and by 
successive stiokes, because they all depend upon the heait, and, as it is 
always in motion, so aie thej’' likeivise always moving togethei, but by 
successive movements ’’ It is Avell to obseive ivith Galen, in this place, 
that the old philosopheis called the aiteiies A^eins 


>De Animal in cap 9 
-De Respiiat cap 20 


[ 31 ] 



I happened upon one occasion to have a paiticular case under my caie, 
which plainly satisfied me of this tiuth A ccitain poison i\as atrceted 
with a laige pulsating tumour on the light side of the neck, called an 
aneuiism, jnst at that pait uheie the aitciy descends into the axilla, 
pioduced by an eiosion of the alien itscH, and daily inci easing in size 
this tumoui was visibly distended as it leeencd the charge of blood 
brought to It by the aiteiy, with each stioke of the lieart the connexion 
of parts was obvious when the bodj of the patient c.ime to be opened 
after his death The pulse in tlic coi icsponding aim uas small, in con- 
sequence of the gieatci poition of the blood being diveilcd into the 
tumour and so intercepted 

Whence it appeals that uhcieicr the motion of tlic blood thiough the 
aiteiies is impeded, whethci it be by compicssion oi infaiction, or intei- 
ception, theie do the remote dnisions of llic ailencs lie.it less foieibh, 
seeing that the pulse of tlie aitciies is nothing nioic than the impulse or 
shock of the blood in those \ cssels 


Cl I AFTER IV 


OF THE iMOTION OF THE HEART AHD ITS AURICLES, 
AS SEEN IN THE BODIES OF LIVING ANIMALS 


Besides the motions aheady spoken of, uc haic still to consider those 
that appertain to the auricles 

Caspai Bauhiii and John Riolan,* most leaincd men and skilful anato- 
mists, infoim us fiom then obsenations, that if ue caiefulh natch the 
movements of the heart in the iniseetion of an animal, ne shall peicenc 
torn motions distinct in time and place, two oi which aie piopoi to the 
auiicles, twm to the ventncles With all dcfeiencc to such authoiitv I 
say, that theie aic foui motions distinct in ]ioint of place, but not of time, 
foi the twm amides move togethei, and so also do the two vcntiicles, in 
such wise that though the places be foui, the times aie only twm And 
this occuis in the followmig mannei 

Theie are, as it weie, two motions going on togethei, one of the 
auricles, anothei of the ventncles, these by no means taking place si- 
multaneously, but the motion of the amides pieceding, that of the heait 
itself following, the motion appealing to begin fiom the amides and 
to extend to the ventncles When all things are becoming languid, and 
the heait is dying, as also in fishes and the colder blooded animals, tlieie 
IS a shoit pause between these twm motions, so that the heart aroused, 
as it were, appears to respond to the motion, now^ more quickly, now more 
tardily, and at length, and wdien near to death, it ceases to respond bj 
its propel motion, but seems, as it were, to nod the head, and is so ob- 
scurely moved that it appeals to give signs of motion to the pulsating 

’Bauhin, lib ii, cap 21 Riolan lib viii, cap 1 

[ 32 ] 



auricle, rather than actually to move The heart, therefore, ceases to 
pulsate sooner than the auricles, so that the auricles have been said to 
outlive it, the left ventricle ceasing to pulsate first of all then its auricle, 
next the right ventricle , and, finally, all the other parts being at rest and 
dead, as Galen long since observed, the right auricle still continues to 
beat , life, therefore, appears to linger longest in the right auricle Whilst 
the heait is gradually dying, it is sometimes seen to reply, after two or 
three contractions of the auricles, roused as it were to action, and making 
a single pulsation, slowly, unwillingly, and with an effort 

But this especially is to be noted, that after the heart has ceased to 
beat, the auricles however still contracting, a finger placed upon the 
ventricles perceives the several pulsations of the auricles, precisely in the 
same way and for the same reason, as we have said, that the pulses of 
the ventricles aie felt in the arteiies, to wit, the distension produced by 
the jet of blood And if at this time, the auricles alone pulsating, the 
point of the heait be cut off with a pair of scissors, you will perceive 
the blood flowing out upon each contraction of the auricles Whence it 
IS manifest how the blood enters the ventricles, not by any attraction 
or dilatation of the heart, but thiown into them by the pulses of the 
auricles 

And here I would observe, that whenever I speak of pulsations as oc- 
curring m the auricles or ventricles, I mean contractions first the 
auricles contract, and then and subsequently the heart itself contiacts 
When the auricles contiaet they are seen to become whiter, especially 
where they contam but little blood, but they are filled as magazines or 
reservoirs of the blood, which is tending spontaneously and, by the mo- 
tion of the veins, under pressure towards the centre, the whiteness in- 
dicated is most conspicuous towards the extremities or edges of the auricles 
at the time of their contractions 

In fishes and frogs, and other animals which have hearts with but a single 
ventricle, and for an auricle have a kind of bladder much distended ivith 
blood, at the base of the oigan, you may very plainly perceive this bladdei 
contracting first, and the conti action of the heart or ventricle following 
afterwards 

But I think it right to describe what I have observed of an opposite 
charaetei the heart of an eel, of seveial fishes, and even of some [of the 
higher] animals taken out of the body, beats "without auricles, nay, if 
it be cut in pieces the several paits may still be seen contracting and le- 
laxing, so that in these cieatures the body of the heart may be seen 
pulsating, palpitating, after the cessation of all motion in the auricle 
But is not this pel chance peculiar to animals more tenacious of life, 
whose radical moistuie is moie glutinous, or fat and sluggish, and less 
leadily soluble^ The same faculty indeed appears in the flesh of eels, 
generally, which even when skinned and embowelled, and cut into pieces, 
are still seen to move 


[331 



Expei’imentmg with a pigeon upon one occasion, aflci the lienil had 
wholly ceased to pulsate, and the auncles loo had become motionless, 

I kept my finger wetted nith sain a and n.iim foi a shoil time upon the 
heait, and obseived, that nndei the mtluencc of this fomentation it 
leeovered new stiength and life, so that both \cnliielcs and auncles 
pulsated, contiacting and lelaxing altei n,ltel^ , lee.illcd as it ncie fiom 
death to life 

Besides this, ho\\c^el I ha\e oceasioimlh obsened, aftci the hcait 
and even its light .iiiiicle liad ceased jnilsating, — nlicn it A\as in aiticulo 
mortis in slioit, that an oliseuic motion, an indul.ition or palpitation, 
lemamed in the lilood itself, 11111011 was eonlaincd in tlic iiglit auiicle, 
this being appaieiit so long as it n.is imbued witli heat .ind simit And 
indeed a eiicumstancc of the same kind is c\ticnicl\ manifest 111 the 
couise of the geneiation of .uimials as m<n be seen 111 the com sc 
of the fiist seien dais of the incubation of the chick A diop of 
blood makes its appeatance whidi palpitates .is Aiislotlc had alieady 
obseived, fiom this, nhen the giowth is fuithei .idiaiiced and tlie chick 
IS fashioned, the auncles of the heait aic foimed, nhieh pulsating henee- 
foitli give constant signs of life ‘When ,it length, and aftei the lapse 
of a few da3’’S, the outline of the bod\ begins to be distinguished, then 
is the ventnculai pait of the heait also inodiiced, but it continues foi 
a time white and appaicntl}’ bloodless, like the lest of the animal, neither 
does It pulsate 01 gne signs of motion I Inne seen a similai condition 
of the heait in the human foetus about the beginning of the thud month, 
the heait being then vhitish and bloodless, although its auricles contained 
a consideiable quantity of puiple blood In the same wav in the egg, 
wdien the cluck ivas foimed and had ineie.ised in si/e, the heait too 111- 
ei eased and aequiicd lentiicles, which then began to icccnc and to 
tiansmit blood 

And this leads me to lemaik, that he who inquues ^erv paitieularlv 
into this mattei wnll not conclude that the heait, as a whole, is the 
piimum viveiis, ultimum 11101 lens — the fust part to Inc, the last to die, 
but lathei its auricles, 01 the pait wdiicli coricsponds to the auncles m 
seipents, fishes, etc, wdiieli both lives befoie the heait' and dies after it 

Nay, has not the blood itself 01 spiiit an obscuie palpitation inhcient 
in it, which it has even appealed to me to letaiii aftei death” And it 
seems veiy questionable wdiether 01 not we aie to sav that life begins 
with the palpitation 01 beating of the heait The seminal fluid of all 
animals — the piolifie spiiit, as Aiistotle observed, leaves their body wntli 
a bound and like a living thing, and natuic in death, as Aristotle=^ iuilhci 
remarks, retiaeing liei steps, leveits to wdieiice she had set out, returns 
at the end of hei couise to the goal wdience she had staited, and as animal 

'The reader will obseive that Haivej r\hen ho speaks of the hemt, •ima’is moans 
the \entncles or ventricular portion of the oigan [Willis IS 17] 

'De Motu Animal cap 8 


[ 34 ] 



generation pioceeds fiom that ■which is not animal, entity fioin non- 
entity, so, by a retrogiade coiiise, entity, by coirniition, is lesolved 
into non-entity, whence that in animals, which was last created, fails 
first , and that which was first, fails last 

I have also observed, that almost all animals have tiuly a heart, not the 
laigei creatines only and those that have led blood, but the smaller, and 
[seemingly] bloodless ones also, such as slugs, snails, scallops, shiiinps, 
crabs, crayfish, and many otheis, nay, even in wasps, hornets and flies, 
I have, with the aid of a magnifying glass, and at the upper part of 
what IS called the tail, both seen the heait pulsating m3’'self, and shown 
it to many others 

But in the exsanguine tubes the heart pulsates sluggishly and de- 
liberately, contracting slowly as in animals that are moribund, a fact 
that may leadily be seen in the snail, whose heart will be found at the 
bottom of that orifice in the right side of the body which is seen to be 
opened and shut in the eouise of lespiration, and whence saliva is dis- 
chaiged, the incision being made in the uiiper aspect of the body, near 
the part which coi responds to the liver 

This, however, is to be observed that in winter and the coldei season, 
exsanguine animals, such as the snail, show no j)ulsations, they seem 
lathei to live after the manner of vegetables, oi of those other pi educ- 
tions which are therefoie designated plant-animals 

It is also to be noted that all animals which have a heart, have also 
auiieles, oi something analogous to auiicles, and further, that wheiever 
the heart has a double ventiicle there are always two auiicles present, 
but not otherwise If you tiiiii to the production of the chick in ovo, 
however, you will find at fiist no moie than a vesicle or auricle, or pulsat- 
ing diop of blood, It IS only by and by, when the development has made 
some progress, that the heart is fashioned even so in ceitain animals not 
destined to attain to the highest peifection in their organization, such 
as bees, wasps, snails, shrimps, crayfish, etc , we only find a eeitain 
pulsating vesicle, like a soit of red oi white palpitating point, as the 
beginning oi piineiple of their life ^ 

^Ye have a small shrimp in these countries, which is taken in the 
Thames and in the sea, the whole of whose body is tianspaient, this 
eieature, placed m a little watei, has frequently aifoided myself and par- 
ticular fiiends an oppoitunity of observing the motions of the heait 
with the greatest distinctness, the external paits of the bodj’' presenting 
no obstacle to oiu view, but the heait being peiceived as though it had 
been seen thiough a window 

I have also obseived the first rudiments of the chick in the course of the 
fourth 01 fifth daj^ of the incubation in the guise of a little cloud, tlie 

’The Editor begs heie to be allo-ned to lemark on Harrei’s obMous perception of the 
correspondence between that permanent condition of an organ in the lower and its 
transitoij condition in the higher animals rWilhs IS-lT] 

[So] 



shell having been leinoved and the egg immeiscd in clear tepid water 
In the midst of the cloudlet in question Iheie was a liloody point so small 
that It disappeaied dining the conliaction and escaped the sight, but in 
the lelaxation it leappcared again, icd and like the point of a pm, so 
that betwixt the visible and invisible, betnixt being and not being, as it 
weie. It gave by its pulses a kind of lepiesentation of the commencement 
of life ^ 

CHAPTER V 

OF THE MOTION, ACTION, AND OFFICE OF THE HEART 

Fiom these and othei obscnations of the like kind, I am peisuaded it 
will be found that the motion of the heait is as follows 
First of all, the aiiiiele conliacts, ,ind m the com sc of its coiiti action 
tliiows the blood (ivhich it contains m aiiqilc quantity as the head of 
the veins, the stoie-house and eisteiii of the blood) into the lentiicle, 
which being filled, the heait laises itsclt stiaightway, makes all its fibics 
tense, contxacts the lentiielcs, and pcifoims a beat, by which beat it im- 
mediately sends the blood supplied to it bv the auiiclc into the aiteiies, 
the light ventiicle sending its chaigc into the lungs by the \csscl which 
IS called lena aiteiiosa, but which, m stiiictuie and function, and all 
things else, is an aitery, the left \culucle sending its chaige into the 
aorta, and thioiigh this by the artciies to the body at huge 
These two motions, one of the ventiiclcs, anothci of the auiicles, take 
place consecutively, but in such a mannci that thcic is a kind of hai- 
mony oi rhythm pieseived betw'cen them, the two concuiiing in such 
wise that but one motion is appaient, especially iii the waimei blooded 
animals, in which the movements in question aie lapid Noi is this for 
any othei leason than it is in a piece of macliineiv, in which, though 
one wheel gives motion to another, yet all the wheels seem to moie si- 
multaneously, 01 in that mechanical coiiti nance which is adapted to fiie- 
aims, wheie the tiiggei being touched, down comes the flint, stiikes 
against the steel, elicits a spaik, wdiich falling among the powdei, is 
Ignited, upon wdiieh the flame extends, enteis the band, causes the ex- 
plosion, piopels the ball and the maik is attained — all of which incidents, 
by leason of the celerity wath wdiich they happen, seem to take place in 
the twinkling of an eye So also in deglutition by the elevation of the 
loot of the tongue, and the compiession of the mouth, the food oi dunk is 
pushed into the fauces, the laiynx is closed by its owui niuseles, and the 
epiglottis, whilst the phaiynx, raised and opened by its muscles no othei - 
wise than is a sac that is to be filled, is lifted up, and its mouth dilated, 
upon which, the mouthful being received, it is forced dowaiwmids by the 

'At the peiiofl Harvey indicates a rudimentan auncle and ventiicle exist, but are 
so transparent that unless with certain precautions their parletes cannot be seen The 
filling and emptying of them, therefore give the appearance of a speck of blood alter- 
natelj appearing and disappearing [WlUis, 1847] 

[ 36 ] 



transverse muscles, and then carried farther by the longitudinal ones 
Yet are all these motions, though executed by different and distinct or- 
gans, performed harmoniously, and in such order, that they seem to 
constitute but a single motion and act, which we call deglutition 
Even so does it come to pass with the motions and action of the heart, 
which constitute a kind of deglutition, a transfusion of the blood from 
the veins to the arteiies And if any one, beaiing these things in mind, 
will carefully watch the motions of the heart in the body of a living an- 
imal, he will perceive not only all the particulars I have mentioned, viz , 
the heart becoming eiect, and making one continuous motion with its 
amides, but farther, a eeitain obscure undulation and lateral inclination 
m the direction of the axis of the right ventricle [the organ], twisting 
itself slightly in pei forming its woik And indeed every one may see, 
when a horse drinks, that the water is drawn in and transmitted to the 
stomach at each movement of the tin oat, the motion being accompanied 
with a sound, and yielding a pulse both to the ear and the touch , in the 
same way it is with each motion of the heait, when there is the deliveiy 
of a quantity of blood from the veins to the arteries, that a pulse takes 
place, and can be heard within the chest 

The motion of the heart, then, is entirely of this desciiption, and the 
one action of the heart is the transmission of the blood and its distribu- 
tion, by means of the arteries, to the veiy extremities of the body, so 
that the pulse which we feel in the arteries is nothing more than the im- 
pulse of the blood derived from the heart 

Whether or not the heart, besides propelling the blood, giving it mo- 
tion locally, and distributing it to the body, adds anything else to it, — 
heat, spirit, perfection, — ^must be inquired into by and by, and decided 
upon other grounds So much may suffice at this time, when it is shown 
that by the action of the heart the blood is transfused through the ven- 
tricles from the veins to the arteries, and distributed by them to all parts 
of the body 

So much, indeed, is admitted by all [physiologists], both from the 
structure of the heart and the arrangement and action of its valves But 
still they are like persons pui blind or groping about in the dark, and 
then they give utterance to diverse, contradictory, and incoherent senti- 
ments, delivering many things upon conjecture, as we have alreadj'- had 
occasion to remark 

The grand cause of hesitation and error in this subject appears to me to 
have been the intimate connexion between the heart and the lungs When 
men saw both the vena arteriosa [or pulmonary artery] and the aiteriae 
venosae [or pulmonary veins] losing themselves in the lungs, of course it be- 
came a puzzle to them to Icnow how or by what means the light ventiicle 
should distiibute the blood to the body, oi the left diaw it from the venae 
cavae This fact is borne v itness to bv Galen, whose words, v hen uniting 

[^ 7 ] 



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'tseZ 



affirm that the l3lood made its way fiom the right to the left ventricle 
by sweating through the septum of the lieait But this fancy I have al- 
ready refuted A new pathway for the blood must theiefoie be pre- 
pared and thrown open, and being once exposed, no fuithei difficulty will, 
I believe, be expeiienced by anyone m admitting what I have already 
pioposed in regaid to the pulse of the heait and aiteiies, viz the passage 
of the blood from the veins to the aiteries, and its distribution to the 
whole of the body by means of these Amssels 

CHAPTER VI 

OF THE COURSE BY WHICH THE BLOOD IS CARRIED 
FROM THE VENA CAVA INTO THE ARTERIES, 

OR FROM THE RIGHT INTO THE LEFT 
VENTRICLE OF THE HEART 

Since the intimate connexion of the heait with the lungs, which is 
apparent in the human subject, has been the probable cause of the errois 
that have been committed on this point, they plainly do amiss who, pie- 
tending to speak of the paits of animals geneially, as anatomists for 
the most pait do, confine their leseaiches to the human body alone, and 
that when it is dead They obAuously act no otheiwise than he who, 
having studied the foims of a single commonwealth, should set about 
the composition of a geneial system of polity, oi who, liaAang taken 
cognizance of the nature of a single field, should imagine that he had 
masteied the science of agiieulture, or who, upon the ground of one 
particulai pioposition, should pioeeed to diaAV geneial conclusions 
liad anatomists only been as coiwersant ivith the dissection of the 
loAvei animals as they aie with that of the human body, the matteis 
that have hitheito kept them in a peiplexity of doubt ivould, in my 
opinion, have met them fieed fiom eveiy kind of difficulty 
And, first, in fishes, in which the heait consists of but a single Amntiicle, 
they having no lungs, the thing is sufficiently manifest ITere the sac, 
vdiich IS situated at the base of the heart, and is the jiait analogous to 
the aiiiiele in man, plainly thiOAvs the blood into the heait, and the heart, 
m Its till 11 , conspicuously tiansmits it bj’’ a pipe oi aiteiy, oi Amssel 
analogous to an aiteiy, these aie facts vdiich aie confiimed by simple 
oculai inspection, as well as by a division of the A^essel, when the blood 
is seen to be projected bj’- each pulsation of the heait 
The same thing is also not difficult of demonstiation in those animals 
that have eithei no moie, oi, as it iveie, no moie than a single ventricle 
to the heait, such as toads, fiogs, seipeiits, and lizaids, vhich, although 
they hai e lungs in a ceitain sense, as thei' have a a oiee (and I liaA e many 
obsei rations by me on the admiiable stiuctuie of the lungs of these 

[39] 



animals, and niatteis <ipei laming -whieli, ho^^cvor, } cannot mliodiice 
m this place), still Ihcir analonn plaml}’’ shows Unit the blood is Irans- 
feiied 111 them from llic ^enls 1 o llic aifciics in the same manner as m 
liighei animals, vi/ , In Ihe action of the heait , the ^^a^, m fact, is patent, 
open, manifest, theic is no difnciilt\, no loom foi liesitntnig about it, 
for ill them the mattci stands piceiselv as it would in man, weie the 
septum of his hcait peifoialcd or icmoicd, oi one \cntiiclc made out of 
two, and this being the case, I im.igme that no one will doubt as to the 
wmy by wdiich the blood mai imss fiom the \ems into the aitciics 
But as theie aic aelualh moie animals which ha\e no lungs than thcie 
aie wdiich be fuinished with them, and in like mannei a gie.itci numbci 
wdiich have only one lenliielc than thcie .11 e which ha\e two. it is open 
to us to conclude, ,]udging fiom the mass 01 multitude of Imng cioatmes, 
that foi the iiiajoi pait, and genoiallv thcie is an open waj bv which 
the blood is tiansmitted fiom the ceins thiough the smuscs 01 ca\itics 
of the heait into the <iitei!cs 

I have, howecei, cogitating with m\sclf. scmi fmthei, that the same 
thing obtained most olwioush 111 the embnos ot those animals that ha\c 
lungs, foi in the foetus the foui \essels belonging to the heait. m/, the 
vena cava, the cena aitciiosa 01 pubnonan aifeic, the aitciia ^cnalIS 
01 pulmonaiy com, and the aitena inagna 01 aoita. .11 c all connected 
otherwise than m the adult, a fact sufficieiitlc known to c\ei\ anatomist 
The fiist contact and union of the sena cn\a with the aitciia senosa 01 
pulmonaiy veins, wdiich occuis befoic the ca\a ojieiis piopeilv into the 
light veiitiicle of the heait, 01 gnes ofi the coi 011.11 \ som. a little ahoie 
its escape fiom the Inci, is b\ a lateial anastomosis, this is an ample 
foiamen, of an oval foim, communicating between the ca\a and the 
aiteiia venosa, 01 piumonaij ccin, so that the blood is ficc to flow in the 
greatest abundance by that foiamen fiom tlic \cna casa into the aiteiia 
venosa 01 pulmonaij’’ vein, and left auiicle, and fiom thence into the 
left ventiicle, and faither, in this foramen ovale, fiom that pait which 
legaids the aiteiia venosa, 01 pulmonaiy seiii, thcie is a thin tough mem- 
biane, larger than the opening, extended like an opciculum 01 coici, 
this membiane in the adult blocking up the foiamen, and adheiiiig on 
all sides, finally closes it up, and almost obliteiates ecciy tiace of it 
This membiane, however, is so contiived in the foetus, that falling looselv 
upon Itself, it peimits a ready access to the lungs and heait, yielding a 
passage to the blood which is streaming fiom the caia, and hindeinig the 
tide at the same time fiom flowing back into that vein All things, m 
short, permit us to believe that in the embiyo the blood must constantly 
pass by this foiamen fiom the vena cava into the arleria venosa, 01 
pulmonary vein, and fiom thence into the left auricle of the heait, and 
having once entered there, it can never legurgitate 
Another union is that by the vena aiteiiosa, 01 pulmonaiy aiteiy, and 
IS effected when that vessel divides into two blanches after its escape 

[ 40 ] 



from tlie light ventiicle of the heart It is as if to the two ti links al- 
ready mentioned a thud were snperadded, a kind of aiterial canal, Gai- 
ned obliquely from the vena arteiiosa, oi pulmonaiy aitery, to perforate 
and terminate iii the arteria magna or aorta In the embiyo, conse- 
quently, there are, as it were, two aortas, or two loots of the aiteria 
magna, springing from the heait This canalis arteiiosus shiinks gradu- 
ally after birth, and is at length and finally almost entirely withered, and 
removed, like the Umbilical vessels 

The canalis arteriosus contains no membrane or valve to direct oi 
impede the flow of the blood in this or in that direction for at the root 
of the vena arteriosa, or iiulmonaiy aitery, of which the canalis arteriosus 
IS the continuation m the foetus, there are three sigmoid or semilunar 
valves, which open from within outwards, and oppose no obstacle to 
the blood flowing in this direction or from the right ventricle into the 
pulmonary aitery and aorta, but they prevent all regurgitation from 
the aorta or pulmonic vessels back upon the right ventiicle, closing 
with perfect accuracy, they oppose an effectual obstacle to everything of 
the kind in the embiyo So that there is also reason to believe that 
when the heart contracts, the blood is regularly propelled by the canal 
or passage indicated from the right ventricle into the aorta 
What IS commonly said in regard to these two great communications, 
to wit, that they exist for the nutrition of the lungs, is both improbable 
and inconsistent, seeing that in the adult they are closed up, abolished, 
and consolidated, although the lungs, by reason of their heat and motion, 
must then be presumed to require a larger supply of nourishment The 
same may be said in regard to the assertion that the heart in the embryo 
does not pulsate, that it neither acts nor moves, so that nature was forced 
to make these communications for the nutrition of the lungs This is 
plainly false, for simple inspection of the incubated egg, and of embryos 
3ust taken out of the uterus, shows that the heart moves precisely m them 
as in adults, and that nature feels no such necessity I have myself re- 
peatedly seen these motions, and Aristotle is likewise witness of their 
leality “The pulse,” he observes, “inheres in the very constitution 
of the heart, and appears from the beginning, as is learned both from 
the dissection of living animals, and the formation of the chick in the 
egg But we further observe, that the passages in question are not only 
pervious up to the period of birth in man, as well as in other animals, 
as anatomists in general have described them, but foi several months sub- 
sequently, in some indeed for several years, not to say for the whole 
course of life, as, for example, m the goose, snipe, and various birds, and 
many of the smaller animals And this encumstance it was, perhaps, 
that imposed upon Botallus, who thought he had discoveied a new pas- 
sage for the blood from the vena cava into the left ventricle of the heart , 
and I ovii that when I met with the same arrangement in one of the 


mtb de Spiritu, cap \ 


[413 



laigei membcis of the mouse family, in llio adult slate, I was myself 
at fiist led to sometlmig of a like conclusion 

Fiom this it will be undci stood that in Ibe liuman embiyo, and in the 
embiyos of animals in whieh the communicalions aie not closed, the same 
thing happens, namely, that the hc.iit b-s its motion piopels the blood by 
obvious and opin passages fiom the Acim c<i\.i into the aoita thiough 
the cavities of both the \cntiieles, the light one locoiMiig the blood fiom 
the auiiele, and ])iopelling it In the ^olla .iitciios.i, oi juilmonaiv aiten, 
and its eontinualion, named the ductus aileiiosiis, into the aoita, the 
left, in like mannei, ehaigod In the contiaction of its auiiclc, uhich has 
leceived its supply thiough the foi.imcn o^ale fiom the vena ca^a, coii- 
tiacting, and pioiccting the blood thiough the loot of the aoita into the 
ti link of that vessel 

In embiyos, consecpicnth . -whilst the lungs aie jet in a stale of in- 
action, peifoiming no function, snb)cct to no motion any iiioie than 
if they had not been jncsent, natuic uses the two leiitiiclcs of the heait 
as if thev foimed but one, foi the tiansmission of the blood The con- 
dition of the embiyos of those animals which ha\c lungs, whilst these 
oigans aie yet in abe} ance and not emiiloj ed, is the same as that of those 
animals wdiich hai e no lungs 

So cleailv, theiefoie, does it appeal in the ease of the foetus, -si/, that 
the heait by its action tiaiisfeis the blood fiom the lena caia into the 
aoita, and that bj^ a loute as oIimous and ojicii, as if in the adult the two 
ventiicles w'eie made to eommunicate bv the lemoial of then septum 
Since, then, we find that in the gicalci numbei of animals, in all, indeed, 
at a ceitain peiiod of then existence, the channels foi the tiansmission 
of the blood thiough the heait are so conspieuous, we hai’-e still to in- 
quiie wheiefoie in some cicatuies — those, namely, that haie w'aiin blood, 
and that have attained to the adult age, man among the number — 
should not eonelude that the same thing is aecomplished thiough the sub- 
stance of the lungs, wdneh in the embiyo, and at a time when the function 
of these oigans is in abeyance, natuie eltects bj'- the diiect passages de- 
seiibed, and wdiich, indeed, she seems compelled to adopt thiough want of 
a passage by the lungs, oi wdiciefoie it should be bettei (foi iiatuie al- 
ways does that which is best) that she should close up the vaiious open 
loiites which she had foimeily made use of in the embiyo and foetus, 
and still uses in all othei animals, not only opening up no new appaieiit 
channels foi the passage of the blood, theiefoie, but even entiiely shut- 
ting up those which foimeily existed 

And now the discussion is bi ought to this point, that they wdio inquiie 
into the ways by which the blood i caches the left veiitiicle of the heait 
and pulmonaiy veins fiom the vena cava, will puisue the ivisest coiiise if 
they seek by dissection to discovei the causes whj'- in the laigei and moie 
peifect animals of matiiie age, natuie has lathei chosen to make the 

[ 42 ] 



blood percolate the parenchyma of the lungs than as in other instances 
chosen a direct and obvious coiiise — ^foi I assume that no other path or 
mode of tiansit can be enteitained It must be either because the larger 
and more peifect animals aie waimei, and when adult then heat greater 
— ^ignited, as I might say, and reqiiiimg to be damped oi mitigated, 
therefoie it may be that the blood is sent through the lungs, that it may 
be tempeied by the an that is inspired, and prevented fiom boiling up, 
and so becoming extinguished, oi something else of the soit But to 
deteiniine these matteis, and explain them satisfactorily, were to entei 
on a speculation in legaid to the office of the lungs and the ends for 
which they exist, and upon such a subject as well as upon what pei tains 
to e ventilation, to the necessity and use of the an, etc , as also to the 
variety and diveisity of organs that exist in the bodies of animals in 
connexion with these matteis, although I have made a vast number of 
obseivations, still, lest I should be held as wandeiing too wide of my 
piesent purpose, which is the use and motion of the heart, and be 
chaiged with speaking of things beside the question, and lather com- 
plicating and quitting than illustrating it, I shall leave such topics till 
I can moie conveniently set them forth in a tieatise apait And now, 
letuining to my immediate subject, I go on with what j^et lemains for 
demonsti ation, viz , that in the more perfect and warmer adult animals, 
and man, the blood passes fiom the light ventricle of the heart by the 
vena arteiiosa, or pulmonaiy aiteiy, into the lungs, and thence by the 
aiteriae venosae, oi pulmonaiy veins, into the left amide, and thence 
into the left veiitiicle of the heart And, fiist, I shall show that this may 
be so, and then I shall piove that it is so in fact 

CHAPTER VII 

THE BLOOD PERCOLATES THE SUBSTANCE OF THE 
LUNGS FROM THE RIGHT VENTRICLE OF THE 
HEART INTO THE PULMONARY VEINS 
AND LEFT VENTRICLE 

That this IS possible, and that Iheie is notlnng to pi event it fiom being 
so, appeals when ve reflect on the vay in which watei percolating the 
eaith pioduces spimgs and imilets, oi when ve speculate on the means by 
vhich the sweat passes thiough the skin, oi the uime thiough the paien- 
cliMiia of the kidnevs It is well knomi that peisons who use the Spa 
valeis, 01 those of La [Madonna, in the teiritoiios of Padua, or others of 
an acidulous oi Mtiiolated natuie, oi vlio simple svallov dunks bv the 
gallon, pass all oft again vithiii an lioiii oi two bv mine Such a quantitv 
of liquid must take some slioit time in the concoction it must pass thiough 
the luci (it IS allowed In all that the juices of the food we consume pass 

E^3] 



hvice tluougli this oigan in the com sc of tlic dajO , it must flow through 
the veins, tluougli the paienehvma of Ihc kidneys, and thiough the ureters 
into the bladder 

To those, therefoie, whom I heai dcining Ih.if Ihe blood, aye the vhole 
mass of the blood may pass thiough the subslance of the lungs, even as 
the nutiitivc nuices pcieolatc the Inci, asseifing such a pioposition to he 
impossible, and by no means to be cnleilaincd as cicdiblc, I icplv, vith the 
poet, that they aic of that lace of men vho, vhen the} vill, assent full 
leadily, and when they vill not. In no manner of means, who, when then 
assent is wmntcd, fcai, and when it is not loai not to gne it 

The paienclnma of the Inci is cvtiomeh dense, so is that of the kidney , 
the lungs, again, aic oi a much loosei Icvluic, and it comiiaiod with the 
kidneys aic absolulel} spongi In the Inei Ihcic is no foieing, no im- 
pelling pow'ci , 111 the lungs the blood is foiecd on b^ the pulse of the light 
^entllcle, the necessaiy eflect of whose impulse is the distension of the 
vessels and poies of the lungs And then the lungs, in icspiiation, aie 
peipetually using and falling, motions, the cfiect of which must needs he 
to open and shut the poies and vessels, pieciseh as in the case of a sponge, 
and of paits having a spongy- stiuctuie, when the\ aic alteinateh coiii- 
piessed and again aie sufteicd to expand The Inci, on the contian, le- 
mains at lest, and is nc\ei seen to be dilated and constiictcd Lasth, if 
no one denies the possibility of the whole of the ingested puces passing 
thiough the livei, in man, oxen, and the laigei animals, geneialh, in oidei 
to leach the vena ca^a, and foi this icason, that if noinishment is to go 
on, these puces must needs get into the ^culs, and theic is no othei wa^ 
but the one indicated, why should not the same aiguments be held of 
avail foi the passage of the blood in adults thiough the lungs’ Win not, 
wutli Columbus, that skillful and leaincd anatomist, maintain and belieie 
the like, fiom the capacity and stiuctuie of the pulmonaiy vessels, fioni 
the fact of the pulmonaiy leins and vcntiiclc coiicsponding with them, 
being always found to contain blood, wdiicli must needs haie come fioni 
the veins, and by no othei passage save thiough the lungs’ Columbus, and 
we also, from wdiat piecedes, fiom dissections, and othei aiguments, con- 
ceive the thing to be clear But as theic aie some w'ho admit nothing 
unless upon authority, let them leain that the tiuth I am contending foi can 
be confirmed fiom Galen’s owoi wmids, namelj'-, that not only may the blood 
be transmitted from the pulmonaiy aiteiy into the pulmonaiy veins, then 
into the left ventricle of the heait, and from thence into the arteries of the 
body, but that this is effected by the ceaseless pulsation of the heart and 
the motion of the lungs in breathing 

There aie, as every one loiows, thiee sigmoid oi semilunar valves situated 
at the orifice of the pulmonaiy aiteiy, wdiich effectually prevent the blood 
sent into the vessel fiom returning into the cavity of the heart Now 
Galen, explaining the uses of these valves, and the necessity foi them, era- 

[ 44 ] 



ploys the following language^ “Theie is eveij'-where a mutual anas- 
tomosis and inosculation of the aiteiies Avith the veins, and they seveially 
tiansmit both blood and spiiit, by ceitain invisible and undoubtedly vem 
narrow passages Now if the mouth of the vena aiteiiosa, or pulmonaij'^ 
artery, had stood in like mannei continually open, and natuie had found 
no contiivance for closing it when lequisite, and opening it again, it 
would have been impossible that the blood could evei have passed by the 
invisible and delicate mouths, duiing the conti actions of the thoiax, 
into the ai tones, for all things aie not alike readilj^ atti acted oi re- 
pelled but that which is light is moie leadily diawn in, the mstiument 
being dilated, and foiced out again when it is conti acted, than that 
which IS heavy, and in like mannei is anj’-thing draivn moie lapidly 
along an ample conduit, and again diiven foith, than it is thiough a 
nairow tube But when the thorax is contracted, the pulmonaiy veins, 
which aie in the lungs, being diiven imvaidly, and powei fully com- 
piessed on eveiy side, immediately foice out some of the spnit they con- 
tain, and at the same time assume a ceitain poition of blood by those 
subtile mouths, a thing that could nevei come to pass weie the blood at 
libel ty to flow back into the lieait thiough the great oiifice of the pul- 
monaiy aiteiy But its leturn thiough this gieat opening being pie- 
yented, when it is compiessed on eveiy side, a ceitain poition of it distils 
into the pulmonaiy veins by the minute orifices mentioned ” And 
shoitly afteiwaids, in the ^ely next chaptei, he says “The moie the 
thoiax contiacts, the moie it stiives to foice out the blood, the moie 
exactly do these membianes (viz , the sigmoid vahes) close up the mouth 
of the vessel, and suffei nothing to leguigitate ’ The same fact he has 
also alluded to in a pieceding pait of the tenth chaptei “Weie theie 
no valves, a three-fold incoin enience Avould lesiilt, so that the blood 
would then perfoim this lengthened course in ^aln, it vould flow in- 
waids duimg the diastoles of the lungs, and fill all then aiteiies, but in 
the systoles, in the mannei of the tide, it would e^el and anon, like the 
Euripus, floAv baekvaids and forwaids by the same vay, with a lecipio- 
eating motion, which would nowise suit the blood This, hove\ei, may 
seem a mattei of little moment, but if it meantime appeal that the func- 
tion of lespiiation suffei, then I think it would be looked upon as no tiifle, 
etc ” And again, and shoitly afteiwaids “And then a Hind incon- 
venience, by no means to be thought lightly of would follow weie the 
blood moved baekwaids dining the expiiations liad not oui IVlakei in- 
stituted those supplemental y membianes [the sigmoid i ah es] “ 'Wlience, 
m the eleienth chapter, he concludes “That the\ ha\e all a roinmon use 
(to wit, the lahes) and that it is to piecent legumitation oi bafkwaid 
motion, each howeiei Inning a piopei fuiution the one set di.iwimr 
matteis fiom the heait, and picwentimr then letuin the otlm diawimr 


’Po I “-VI I’Tiuiim lib M cnp 10 


[ 41 ] 



nialtcis into llio luMil, and ])i{‘\(‘nlin!>: llicii (sc.ipc lioiti it ]‘\)i naluic 
ne^cl iiitondcd to dislicss the lioail uilh m'cdlfss l.iboui . ncillioi to bini" 
aiis>li 1 into the oiiran -wliub it liad boon bibtoi to li.i\o Kept ,m,n, noi to 
lake fiom it ag.iin aught ^\hloll it ■was lorpiisito should lio hiouglit Since, 
llien, thoic aie Join oiduos in all, two in oithoi \onliiolo, one oi these in- 
duces, the othei odiu os ’ And .iiraiii ho sa'\ s “ h’ai thoi , siiuo thoie is one 
■\cssel, eonsistni”: ol a siinjih' tnnio inijil.iiitod in the hoait, <ind aiiothei, 
hoMiig a double lunu extending lioni it (Tibdin is hoie speaking o£ the 
1 ight side of the he.ii t but 1 extend his obson at ions to the left side also), 
a kind of lesenoii had to be ino\idod, to whuh both belonging, the 
blood should be diann in b\ tlu ono .uul st nt out b\ the othei ” 

This aignment Clalcn addiuos ioi the tiansit of the blood bj the light 
^entllcle fiom the leiia caia into the lungs, but we (an use it with still 
gicatei ]no]nie 1 i,, niereh changing the teiius foi the jiassage of the 
blood fiom the leins tlnougli the lusiit into tlu aifoiios Fiom Galen, 
howc^el, that gieat man that iathei ot plnsuians it eleaih apjiears 
that the blood passes thiongh tlu lungs liom the pnlmonaiv aiten into 
the niiniite blanches oi the luiliiioiian \(iiis iiiged to this both bv the 
pulses of the lieait <ind In the iiiotioiis of the lungs and tlioiax that the 
lieait 11101 eo^el is iiieessantl\ KMeniiig .ind ex])t‘IIing the blood b^ and 
fiom Its ventiules, as lioin <i niaga/ini' oi dstfuii, and ioi this end is 
fuinished witli foui sets ol \al\es, two selling ioi the indiution and two 
foi the cduetion ol the blood lest, like the Fanpnis, it should lie inconi- 
modioush sent hithei and Ihitlui oi flov back into the (a^lt^ which it 
should ha\o quitted, oi ()uit the pait wlieic its incsencc was icqiincd, and 
so the lieait be oiipiessed with kiboiii in \ain, and the ofiiec of the lungs 
be inteifeied wutli ' Finally, oui position that the blood is continually 
passing fiom the light to the left ■scmtiicle fiom the ^ eiia ca\a into the 
aoita, thiough the poioiis stiuetiiie ol the lungs, jilainh appeals fiom 
tins that since the blood is inccssanth sent liom the light ^entllclc into 
the lungs bj^ the pulmoiiaiy aiten, and in like maiinei is incessantly 
diawm fiom the lungs into the left lentiide, as aiipcais fiom what pie- 
eedes and the position of the lahes, it c.innot do othei wise than pass 
thiough continuously And then, as the blood is incessantly flowing into 
the light ventiicle of the hcait, and is continually passed out fiom the 
left, as appeals in like maiinei, and as is obi lous both to sense and ica- 
son, it IS impossible that the blood can do otheiwise than pass continually 
fiom the vena cava into the aoita 

Dissection consequently show's distinctly w'hat takes place [in legaid 
to the tiaiisit of the blood] in the gieatei iiumbei of animals, and in 
deed in all, up to the peiiod of then [foetal] matuiity, and that the 
same thing oecuis in adults is equally eeitain, both fiom Galen’s woids, 
and wdiat has alieady been said on the subiect, only that in the foimei 

'See the Commentarv of the leainecl Hofmann npon the SKth Book of Galen Be Usu 
Partium a -vvork which I first san after I had nutton nhat picceclcs 

[ 46 ] 



the tiansit is effected by open and obvious passages, in the lattei by 
the obscure poiosities of the lungs and the minute inosculations of 
vessels Whence it appeals that, although one ventiicle of the heait, the 
left to wit, would suffice for the distiibutioii of the blood over the body, 
and its eduction fioin the vena cava, as indeed is done m those cieatuies 
that have no lungs, natuie, neveitheiess, when she oidained that the same 
blood should also peicoiate the lungs, saw heiself obliged to add anothei 
ventricle, the right, the pulse of which should foice the blood fiom tlie 
vena cava thiough tlie lungs into the cavity of the left ventiicle In this 
way, theiefoie, it may be said that the light yentiicle is made foi the sake 
of the lunas, and foi the tiaiismissioii of the blood tluough them, not foi 
their nutiition, seeing it weie unieasonable to suppose that the lungs le- 
quiied any so much moie copious a supply of nutiiment, and that of so 
much puiei and moie spiiitous a kind, as coming immediately fiom the 
ventricle of the heart, than either the brain vvuth its peculiarly pure sub- 
stance, 01 the ej^es ivitli their liistioiis and tiiily admiiable structure, or the 
flesh of the heart itselt, which is moie commodiously nourished by the 
coronary aitery 

CHAPTER Vin 

OF THE QUANTITY OF BLOOD PASSING THROUGH THE 
HEART FROM THE VEINS TO THE ARTERIES, AND 
OF THE CIRCULAR MOTION OF THE BLOOD 

Thus lai I have spoken of the passage ot the lilood fiom the veins into 
the aiteries, and of the mamiei m Avliich it is liansmittcd and distiibuted 
by the action of the heart, points to vhicli some, moyed either hy the 
authoiity of Galen oi Golumbus, or the reasonings of otheis, Avill giye in 
then adhesion But uhat lemams to lie said upon the cjiiantitv and soiiiee 
of the blood AAdiich thus passes, is ot so noAcl and unheaid of cbaiactei, 
that I not oiiIa' feai in]uiA' to nnself fiom the eiiAw of a feA\, but I tremble 
lest I liaAU mankind at large for iiiA* enemies, so much doth A\oiit and cus- 
tom, that become as another nataie, and doctiine once soun and that hath 
stiiiek deep root and lespect foi antiquitA' influence all men Still the 
die IS cast, and iiia' trust is in my loA'e of truth, and the candour that 
Uiheies in cultiAated minds And sootli to saA", aaIicii I siUACAmd my 
mass of evidence, A\hetlier deiiAcd from aia isections, and niA* Aaiioiis 
lefiections on them oi from the Aentndes Oi tlie lie.nl, .nid tlie \ essels 
that entei into and issue liom them tlie sAinnietiA and si/e ol these 
conduits — loi natuie doing nothina in A.nn, v ould iieAci Iuac gnen 
tliem so huge a iclatiAc si/e AAilhout a ])uiposo — oi fiom the anange- 
ment and mtnuate stiuctuie ot the Aal\es in paitnulai and of tlie othei 
parts of the heart nr general A\ith nmin thnms besides I jiequenth and 
senoush hethomrht me and lonu leAohed in nn mind A\hat mnrht be 
the quantilA ot blood winch aa.is tiausmrttrd in hoA. shoit a tunc its 

i^n 



i'c (‘l((H‘t('(l ,iml llu* like, .nul not (indnifj: il ijossihlo that 
this could lie suiiiilu'd 1 )^ the |uicos oi llic iniicslcd Jilimont Mdlioulthc 
\cins on llio one h.uid InHoininir diainod, and the .niciios on the ollici 
"etliiiii lupluicd thionyli the e\(essi\e ol Idood, unless the hlood 

should soinehou find its m<i\ lioin the .iiiei les into the \enis, and so ictinn 
to the infill side ol tin* heait, 1 heuan to think Mhethei theie niu,dit not 
he A MO'iioN, \s II wiM, i\ A ( nu'ia Vow this ] alteiwaids lound to ho 
tine, and 1 finalh saw th.il the hlood. loiu'd h\ the adion ol the lelt \en- 
tiielc into the ai tones, was distnhnted to the both rit laifi:e, and its soicial 
paits, 111 the same nianiiei .is it is sent thioimh the hums, iniiielled 1 )% the 
iu>ht ^elltll(le into the ]iulnion.ii \ alien, and th.it it then ji.issed thioiiirh 
the %eiiis and .doni> the seii.i (.i\a and so lound to the leit sentiidc in the 
maniici alie.uh indu.ited Whnii motion we ni.n he .illowed to enli cn 
eulai, in tiie same w.n .is Aiistotle s.i\s th.it the .in .ind the i.ini emulate 
the ciiLul.ii motion oi the supeiioi bodies, loi the moist e.nth, wanned 
by the sun e\ai)oi.ites the \ .1)10111 s diawn ipiw.iids .11 e eondeiised and 
desceiidinf>: in the ioim of lain, moisten the eiiilh .iir.ini .ind In this 
aiiaiigeiiient .11 e <ieneiations ot Inimr thni)^s ))iodn(ed, .ind in like 
iiiannei too .lu tempests .ind iindeois i nfi:endei I'd In tin' in (ill. 11 motion, 
and bj the .i])])io.ieh and leeession oi the sun 

And so, 111 .ill likelihood, does it (ome to ji.iss 111 the boih thiou{rh 
the iiiotion of the blood, the \aiions ji.iils .11 e noniished, chciishod 
quickened b^ the waimei, nioie ))eil(*tt, i.ijioious sjniitous and, as I 
may sa^, aluiientne blood, wliieh on the eontian, 111 cont.iet with these 
paits becomes cooled, coagulated, .ind, so to s])e.ik, eflete, whence it 
letuins to Its so\ ei eign the he.iit, as it to its souiee, 01 to the inmost 
home of the boih , theie to ieeo\ei its state ol evcelleiiee oi )iciicctioii 
Heie it lesumcs its due ^luldlt^ and lecenes an iniusion of natuial heat 
— poweiful, feicid, a kind ot tieasun of lile, and is impiegnatcd with 
spiiits, and it might be s.iid with bals.nn, and thence it is again dis- 
peised, and all this c 1 e)iends on the motion .ind .ictioii of the heait 

The heait, consequently, is the begninnig of liic the sun of the micio- 
eosm, ei en as the sun 111 his tuin might well be designated the heait of 
the woild, foi it IS the heait b;) whose Mitiio and pulse the blood is 
moved, ]ieifectcd, made apt to nouiish, and is ]nescncd fiom coim])tioii 
and coagulation, it is the household dnniitA’- which, dischaigiiig its func- 
tion, nouiislies, eheiislies, quickens the whole bod's, and is indeed the 
fonndation of life, the sonice of all action But of these things w'e shall 
speak moie oppoitunelj^ ivlien ive come to speculate u]ion the final cause 
of this motion of the heait 

Hence, since the veins aie the conduits and vessels that tianspoit the 
blood, they aie of two kinds, the cava and the aoita, and tins not b'S 
leason of theie being two sides of the body, as Aiistotle has it, hut be- 

[4S] 



Cause of Die dill ei once of ollice, noi yol, as is commonlj'’ said, in conse- 
quence of any dncisity of stiuctnic, Loi in many animals, as I have said, 
the 1 ein does not dillci fi om the nileiy in the thickness of its tunics, 
but solely in viilue of then seveial dcsl lines <ind uses A vein and an 
aitei^q both styled vein by the ancients, and that not undeseiyedly, 
as Galen has icmaiked, because the one, the aiteiy to wit, is the vessel 
which caiiies the blood fiom the heail to the body at laige, the other 
01 vein of the picsent day bunging it hack fiom the geneial S3’'stem to 
the heait, the foimei is the conduit fiom, the lattei the channel to, the 
lieait, the latter contains the ciudci, clfete blood, lendeied unfit foi 
nutiition, the foimei tiansniils the digested, peifeet, peculiaily nutritive 
fluid 

CHAPTER IX 

THAT THERE IS A CIRCULATION OF THE BLOOD IS 
CONFIRMED FROM THE FIRST PROPOSITION 

But lest air>’one should say that we give them woids oiilj’’, and make 
ineie specious asseitions without any loundatioii, and desiie to innovate 
without sufficient cause, thice iioints picsent themselves foi confiimation, 
which being stated, I conceive that the tiuth I contend foi will follow neces- 
saiilj’’, and appeal as a thing olnious to all Fust, — the blood is incessantly 
tiansniitted bj’’ the action of the heait fiom the vena cava to the aiteiies 
in such quantitj^, that it cannot he supplied fiom the ingesta, and in such 
wise that the whole mass must veiy quicklj’’ pass thiough the organ, 
second, — the blood undei the influence of the aiteiial pulse enteis and is 
impelled in a continuous, equable, and incessant stieam thiough eveiy 
pait and membei of the body, in much laigei quantity than were suffi- 
cient foi nutiition, 01 than the whole mass of fluids could siqiply, thud, 
— the veins in like mannei letuin this blood incessantly to the heait 
fiom all paits and membei s of the body These points pioved, I conceive 
it will he manifest that the blood circulates, i evolves, piojielled and 
then letuinmg, fiom the heait to the extiemities, fiom the extiemities 
to the heait, and thus that it peifoims a kind of eiiciilai motion 

Let us assume eithei aibitiaiily oi fiom experiment, the quantity of 
blood which the left ventiicle of the heart will contain when distended 
to be, say two ounces, tliiee ounces, one ounce and a half — in the dead 
body I have found it to hold iipwaids of two ounces Let us assume 
fiiithei, how much less the heart will hold in the conti acted than in the 
dilated state, and how much blood it will piojeet into the aoita upon 
each contraction, — and all the woild allows that with the systole some- 
thing is always projected, a necessaiy consequence demonstrated in the 
thud chapter, and obvious from the structure of the valves, and let us 
suppose as appioaching the tiuth that the fourth, or fifth, oi sixth, oi 
even but the eighth part of its chaige is thrown into the artery at each 

[ 49 ] 



eonti action, tins would gnc oillioi li.ilf ,ni miiuc m llnee diaclims, or 
one cliaclnn ol lilood as inopolled In llic Instil at (sn li jnilsc into tlie 
aoita, which qu<iutil;s, 1)\ i eason ol llic i.ihcs at the loot oi the vessel, 
can by no means ictuin into llie Mmliule >\o\\ ni the coinse ot half 
an horn, the hc.iit mil lune made moie Ih.in one thousand bc.its, in some 
as many as tno, tliiee, .ind ewn loin llioiisand .Mullii)l\ mg the nunibei 
of diaehms piopelled In the numln-i o] ])uls(s, m sli.ill li.ne eithei one 
thousand hall ounces, oi one thous.ind umes tiiiee diaclims, oi a like 
piopoi tional qiianlni ol blood ai i oi dnia to 1 be .imount i\ Inch i\ e assume 
as piopelled mlh tsu h slioke ol tin In.iil sent iiom this oig.in into 
the aiteij , a laigei (luantll^ in t\ii\ c.ise than is (ont.uiied in thcMholc 
body' In the same m<i\ in the shei p oi doic, sa\ fli.it but <i single scuiple 
oi blood passes with cacli stioke ol tin In .11 1, in one-h.dl lioui ue should 
have one thousand suiqiles, 01 aimut time iiounds .iiul a h.ilt of blood 
injected into the aoita, Init tlie bod\ oi mithei .miin.il eont.iins aboie 
foui pounds of blood, .1 i.icl ulinh I li.ut misell .isceitamed in the ease 
of the sheep 

Upon this supposition, theieioie, assunu'd mcieh .is a gioiind loi 
leasomng, ue sec the iihole m.iss oJ lilood p.issing tluough the hc.iit, 
fiom the veins to the ailciies, <iiul in like m.innci tluough the lungs 

But let It be said that this does not t.ikc jil.ice in hali an hom, but in 
an houi, 01 e\cn in a d.u , .inv \\<i\ if is still ni.iiiilest that 11101 c blood 
passes tluough the hcait 111 lOiisLipieme ol its .ntioii, than e.in citlici be 
supplied by the uhole oi tlie ingest.i, oi th.in c.in lie contained in the 
veins at the same moment 

Noi can it be allowed that the hcait in tonti.itting sometimes piopels 
and sometimes docs not piopcl, 01 at most jnopcls but \ei\ little, a iiieic 
nothing, 01 an imagmai^ sometliiiig ail this, indeed, has alie.uh been 
leiuted, and is, besides, contiaij both to sense and icason Foi if it be a 
necessaiy effect oi the dilatation oi the heait that its %entiicles become 
filled wuth blood, it is equally so that, coiitiactmg, these c.iMties should ex- 
pel then contents, and this is not in am tiifling measuie, seeing that 
neithei aie the conduits small, 1101 the contiactions iew in iiumbci, but iic- 
quent, and always in some ccitaui piopoition, whcthei it be a tiind 01 
sixth, 01 an eighth, to the total capacity of the vciitiiclcs, so that a like pio- 
portion of blood must be expelled, and a like piopoitioii leceived ivitli each 
stroke of the lieaii., the capacity of the veiitiicle coiiti acted ahvays beainig 
a ceitain lelation to the capacity of the ventiicle when dilated And since 
in dilating, the ventiicles cannot be supposed to get filled ivith nothing, 
01 with an imaginaiy something, so ui contiacting they iievei expel noth- 
ing or aught imaginaiy, but ahvays a ceitain something, viz, blood, 111 
propoition to the amount of the contiaction Whence it is to be infeiied 
that if at one stioke the heait in man, the ox 01 the sheep, ejects but a 
single diachm of blood, and there aie one thousand stiokes in half an 

[ 50 ] 



hour, in tins intei\.il llieio wi]\ h.nc been ten pounds five ounces expelled 
weie tlieie vitli each sliokc tvo diaclniis expelled, the quantity would ol 
coiuse amount to twcida pounds and ten ounces, wcic tlicie half an ounce, 
the quantity would conic to roil^-oiic pounds and eight ounces, and weie 
theie one ounce it would be as much as eight3’’-thiec pounds and four 
ounces, the vhole oi A\hich, in the coiuse of one half-houi, Avould have 
been transfused from the veins to the ait cues The actual quantity of 
blood expelled at each stioke of the heart, and the circumstances undei 
which it IS eithei gieatei oi less than oidinaiiq I leave foi paiticulai 
deteimination aftciwaids, fiom iiumeious obscivations which I liaise made 
on the subject 

Meantime this much I knov, and vould hcic jiioclaim to all, that the 
blood IS tiansfused at one tunc in laigci, at anothci in smallei quantity, 
and that the circuit of the blood is accomplished now moie lapidly, noiv 
moie slovly, accoiding to the tcmpei ament, age, etc, of the individual, to 
external and inteiiial eiicumstanccs, to natuials and non-natui als, — sleep, 
lest, food, exeieise, aficctions of the mind, and the like But indeed, sup- 
posing even the smallest quantity of blood to be passed thiough the heait 
and lungs ivith each pulsation, a vastly gieatei amount would still be 
throAvii into the arteiies and ivholc body, than could by any possibility be 
supplied by the food consumed, in shoit it could be fuinished in no otliei 
Avay than by making a ciicuit and letuining 

This tiuth, indeed, piesents itself obviously before us when we considei 
what happens in the dissection of living animals, the gieat aiteiy need 
not divide, but a veij^ small bianch only (as Galen even pioves in 
legal d to man), to haAm the Aidiole of the blood in the body, as well that 
of the veins as of the ai tones, diained aAvay in the couise of no long 
time — some half-houi oi less Buteheis aie Avell aAvaie of the fact and 
can beai Avitness to it, foi, cutting the tin oat of an ox and so diAuding 
the vessels of the neck, in less than a quaiter of an houi they have all 
the Amssels bloodless — the Aidiole mass of blood has escaped The same 
thing also occasionall3^ occuis Avith gieat lapidity in peifoiming amputa- 
tions and lemoAung tumouis in the human subject 

Nor would this aigument lose any of its foice, did any one say that 
in killing animals in the shambles, and peifoiming amputations, the 
blood escaped in equal, if not pei chance in laigei quantity by the veins 
than by the aiteiies The contiary of this statement, indeed, is certainly 
the tiiitli , the Amins, in fact, collapsing, and being without any propelling 
powei, and finther, because of the impediment of the valves, as I shall 
show immediately, poui out but veiy little blood, Avhilst the aiteiies 
spout it foith with foice abundantly, impetuously, and as if it were 
piopelled by a syiinge And then the expeiiment is easily tried of 
leaAung the vein untouched, and only dividing the aiteiy in the neck of a 
sheep 01 dog, Avhen it aviII be seen Avitli Avhat foice, in Avhat abundance, 

[ 51 ] 



and how quiekl}^, the whole lilood in Ihc body, of llie -veins as well as of 
the aileiies, is emplied But the aitcncs locene blood fiom the veins 
in no other vay than by ti ansmission Ihiongh the hcail, as we haAe 
alieady seen, so that if the aoila be lied at the base of the heait, and 
the caiotid oi any othei .uleiy be opened, no one vill now be sin- 
piised to find it empty, and the -veins only leplete vith blood 

And now the cause is manifest, n heiefoie in oin dissections we usually 
find so Luge a quantity of blood in the Acins, so little in the aiteiics, 
wheiefoic theie is mueh in the light Aontiiele, little in the left, ciicum- 
stances which piobably led the ancients to believe that the aiteiics (as 
then name implies) contained nothing but sjinits dining the life of an 
animal The tiuc cause of the dificience is this jieihaps that as theicis 
no iiassage to the aiteiics, save thiough the lungs and flic hcaif, when an 
animal has ceased to bieathe and the lungs to move, the blood in the 
pnlmonaiy aitei^' is pi evented fiom passing into the pulnionaiy veins, 
and fiom thence into the left ventiiclc of the he.iit, pist as vve have al- 
leadj’- seen the same tiansit ])i evented in the embivo, In the want of 
moyement in the lungs and the .ilteinatc ojicning and shutting of then 
minute oiifiecs and invisible jioies lint the heait not ceasing to act at 
the same piccise niomont as the lungs, but suiviving them and continuing 
to pulsate foi a time, the left vcnliicle and ai tones go on distiibiiting 
then blood to the body at laige and sending it into the veins, leccning 
none fiom the lungs, hovvcvci, tlicv aie soon cxh.iusted and left, as it 
weie, empty But even this fact confiims oui views, in no tiifiing 
niannei, seeing that it can be aseiibcd to no othei than the cause vve have 
just assumed 

Moieovei it appeals fiom this that the moie fieqiicntly oi foicibly 
the aiteiies pulsate, the nioie speedilj will the body be exhausted in an 
henioiihage Hence, also, it happens, that in fainting fits and in states 
of alaim, wdieii the heait beats moie languidlv and with less foice, 
heiiioiiliages aie diminished oi aiicsted 

Still fiiithei, it is from this that aftci death, wdieii the heait has ceased 
to beat, it IS impossible by dividing citlici the jugulai oi feiiioial veins 
and aiteiies, by any efCoit to foice out moie than one-half of the whole 
mass of the blood Neithei could the butchei, did he neglect to cut the 
thioat of the ox which he has knocked on the head and stunned, until 
the heait had ceased beating, ev’^ei bleed the caicass eflectiially 


[ 52 ] 



CHAPTER X 

THE FIRST POSITION^ OF THE QUANTITY OF BLOOD 
PASSING FROM THE VEINS TO THE ARTERIES 
AND THAT THERE IS A CIRCUIT OF THE 
BLOOD, FREED FROM OBJECTIONS, 

AND FARTHER CONFIRMED BY 
EXPERIMENT 

So fai 0111 fiist position is confiimcd, wlielher the thing be ref ei red 
to calculation oi to expeiiinent and dissection, \u , that the blood is inees- 
santlj^ infused into the arteiies in laigei quantities than it can be supplied 
by the food, so that the ^Yhole parsing ovei in a shoit space of time, it is a 
inattei of necessity tliat the blood perfoiin a eiicuit, that it return to 
whence it set out 

Bnt if any one shall heie object that a laige quantity may pass thiongh 
and yet no necessity be found foi a eii dilation, that all may come from 
the meat and dunk consumed, and quote as an illustiation the abundant 
supply of milk in the mammae — foi a cow will give three, four, and 
even se^en gallons and moie in a day, and a woman, two oi thiee pints 
whilst musing a child oi twins, which must manifestly be derived from 
tlie food consumed, it may be answeied, that the heait by computation 
does as much and nioie in the couise of an lioui oi two 
And if not yet convinced, he shall still insist, that when an aiteiy is 
divided a pieteinatuial route is, as it weie, opened, and that so the 
blood escapes m toiients, but that the same thing does not happen in 
the healthy and uninjuied body when no outlet is made, and that m 
arteiies filled, oi in then natural state, so laige a quantity of blood 
cannot pass in so slioit a space of time as to make any letuin neeessaiy , 
— ^to all this it may be answered, that fiom the calculation already made, 
and the leasons assigned, it appears that by so much as the heart in its 
dilated state contains in addition to its contents in the state of eonstiie- 
tion, so much in a geneial way must it emit upon each pulsation, and 
in such quantity must the blood pass, the body being healthy and 
naturally constituted 

But in seipents, and several fishes, by tying the veins some way below 
the heait, you will peiceive a space between the ligature and the heart 
speeddy to become empty, so that, unless you would deny the evidence 
of youi senses, you must needs admit the return of the blood to the heait 
The same thing will also plainly appeal when we come to discuss our 
second position 

‘Proposition — F A wr 1940 

[ 53 ] 



Let iis heic coneludc a e\ 4 inii)l(‘ (onfiimmy’ .ill tli.it li.as 

been s.nid. .nid Loin wlneh exon one lu.n obliiin com id ion tlnongli the 
testimony of Ins own ox es 

If <1 lixc sn.ilvc be laid open, tlio lusid xxill bo soon pulsaling qiiictlx, 
distiiictlx’’ foi 11101 c Ilian .in lioni, 1110x1111; like .1 xxoini, oonti.'icling in 
its longitndin.il dimonsions (foi il is ol .111 oblong sli.ipo) and piopclliiig 
its contents, bocoiniiig oi a indoi ooloiii in tlio sx stole, of a dccpci lint 
in the dmstole, and almost all things else bx xxhioh I haxc .ilieady said 
that the liiith T contend foi is osl.iblishod, oiilx that heio ex cix thing 
takes place moic sloxxlx, and is moio distimt 'I’his iioiiit in p.uticiilai 
max’' be obseived moic dc.iilx than the noond.ix sun the xona c.ixa cnteis 
the heait .it its loxxei pail, the aitoix (puts it .it tlu supoiioi pait, the 
xmin being iioxx soi/od oithoi x\ilh foi oops 01 bclwoon the fiiigoi and 
thnmb, and the coin so of the blood loi sumo sp.ioo below the licai t intei- 
lupted, x'ou xxill iioicoixe the pint lh.1l intoixonos between the fingcis 
and the hcait almost immcdiatolx to iiooome omiitx, the blood being c\- 
hausted bx' the action oi the hoail at the s.inic time the hcait xxill hc- 
coine of a much palei coloiii oxen in its stale oi dil.it.it 1011. than it was 
befoie, It IS also smalloi than .it iiisi fiom w.iiiting blood, and then it 
begins to beat iiioie sloxxlx, so that it seems at length as if it xxcic about 
to die But the im])cdimenl to the flow of blood being icmoxcd, in- 
stantly the eoloui and the si/c oi the hc.iit .110 lestoied 

If, on the coiitiaix, the aiteix instead of the xeiii be compicsscd 01 
tied, you xxill obseixc the ]).ii 1 bctxxecn the obstacle and the hcait, and 
the heait itself to become 11101 diiialelx distended, to assiinic a deep 
puiple 01 exen livid eoloui, and at length to be so much oppicssed xxitli 
blood that you xxill believe it .ibout being choked, but the obstacle le- 
moved, all things immediatelj ictuin to thou piistiiie state — the heait 
to its eoloui, size, stioke, etc 

Ileie, then, xve have exidciue of two kinds of death cvtinction fioin 
deficiency, and suftocatioii fiom excess Examples of both liaxm now 
been set befoie xmn, and you haxc had ojipoi tnintx of xnexxing the tiiitli 
contended foi xvith yoiii oxvii exms 111 the hcait 

C HAPTEN XI 

TEE SECOND POSITION IS DEEONSTNATED 

That this may the nioie cleailv appeal to exeix’’ one, I haxm heie to cite 
certain expeiiments, fiom xvliieh it seems obxious that the blood enteis 
a limb by the aiteiies, and letuins fiom it hr the veins, that the aitciies 
aie the vessels eaiiymg the blood fiom the heait, and the x>-eins the letiiin- 
iiig channels of the blood to the heait, that 111 the limbs and extieme paits 
of the body the blood passes eithei immediately by anastomosis fiom the 
arteries into the xmins, 01 mediatelx'^ by the poies of the flesh, 01 in both 

[ 54 ] 



^^a^s, as has alicadv been said in speaking of the passage of the blood 
thiough the lungs n hence it apjieais manifest that in the ciiciiit the 
blood 11101 cs fioin tlience liitlicr and fioni lienee tliithci , fiom the ceiitie 
to the extiemities, to i\it, in fiom the evticme paits back again to the 
ceiiUe Finally, upon the gionnds oi ealciihitioii, Mith the same elements 
as befoie, it mil be obiioiis that the qiiantitv can neither be accounted 
for by the ingcsta, noi vet bo hold nccessaiv to imtiition 
The same thing Mill also appeal in regard to ligatiiies, and vheiefoie 
they aie said to d]aii\ though this is neither fiom the heal, nor the pam, 
nor the laciiiim thei occasion nor indeed fiom anv other cause let thought 
of, it will also explain the uses and adiantages to lie deiived fiom ligatiiies 
m medicine, the piinciplc upon mIiicIi Ihev eitliei suppress or occasion 
hemorihage, hoiv thei induce sloimhing and moic extensive moitifieation 
m cxti emit ICS, and lion Ihev act in the easliation of animals and the le- 
moial of Marts and fleshv tiimouis But it has come to pass, fiom no one 
having duly MOighcd and uiidci stood the causes and latioiiale of these 
various effects, that though almost all, upon the faith of the old M'liteis 
recommend ligatiiies in the ticatment of disease, vet vciv feu compiehend 
then piopei emploimcnt, oi demo anv leal assistance flora them in 
eff'ectiiig Clues 

Ligatiiies aie eithei iciv tight or of middling tightness A ligatuie I 
designate as tight oi peitect when it is diaun so close about an extremity 
that no vessel can be felt pulsating beyond it Such a ligatuie M'e use in 
amputations to eoiitiol the floM’ of blood, and such also aie employed in 
the eastiation of animals and the lemoial of tumouis In the latter in- 
stances, all afflux of nutiiment and heat being pi evented by the ligatuie. 
Me see the testes and laigc fleshv tumouis dn indie, and die, and finally 
fall off 

Ligatiiies of middbng tightness I legaid as those which compiess a 
limb fiimly all aiound, but shoit of pain, and m such a wav as still suffeis 
a eertam degiee of pulsation to be felt m the aiteiy bevond them Such 
a ligature is m use m blood letting, an opeiation iii Mhieh the fillet applied 
above the elboM" is not diavii so tight but that the aiteiies at the wiist 
may still be felt beating undei the fiiigei 

Now let anj’- one make an expeiiment upon the aim of a man, either 
using such a fillet as is employed in blood letting, or giaspmg the limb 
lightly Mutli Ins hand, the best suboeet for it being one who is lean, and 
M'ho has laige veins, and the best time aftei exeieise, Mdien the body is 
Mmrm, the iiulse is full, and the blood earned m larger quantity to the 
extiemities, foi all then is more conspicuous, undei such cneiimstances 
let a ligatuie be thioMui about the extiemity, and drawn as tightly as 
can be borne, it Mill first be perceived that beyond the ligatuie, neithei in 
the Muist nor aiiywheie else, do the aiteiies pulsate, at the same tune that 
immediately above the ligatuie the aiteiy begins to rise highei at each 

[ 55 ] 



diastole, to thiob inoie Molontlv, and to swell in its Mcnntj w-ith a 
land of tide, as if il slioio to bic.ik Ihroujrli and ommcohio llic obstacle 
to its cimcnt, the aiteiv Ikmo, in sboit, apiieais .is li it iveie pie- 
leinatnially full The hand niidei such eiuninsl.inees letains its natiiial 
coloiii and apiioaianec in the coinse of tniie it begins to fall somewhat 
in tenipeiatuie, indeed, but nol]iin}>: is chaun into it 

Aftei the bandage has licen Kejit on toi some shoil time in this wai, 
let it be slackened a little, In ought to that state oi teim of middling tight- 
ness 11111011 IS used in bleeding and it will be seen that the whole hand and 
aim Mill iiistanth bceonie deejdi sunnsed .ind distended and tlic icms 
show themselves tumid and knotted, .litei ten oi fifteen jnilses of the 
aileiv, the hand will be ]icieei\ed exeessneh distinded. inteeted, goigcd 
Muth blood, (h(iu'}i, as it is s.iid, bi this middling lig.it me, without pain 
01 heat, 01 anv hoiioi of a i.ievunn oi am othei e.iuse lot indieatcd 

If the fingci be apiilied o\ei the .iiteii .is it is pnls.it ing In the edge 
of the fillet at the moment oi sl.ukening it, the blood will be felt to glide 
tluough, as It MOie, undeineath the fingei , and he too uiion whose aim 
the experiment is made, when the lig.iluie is sl.ukened is distineth con- 
scious of a sensation of waimth, and oi something m/ . a stieaiii of blood 
suddenly making its wai along the eouise of the lessels and difiusing 
itself tluough the hand which .it the s.inie time begins to feel hot, and 
becomes distended 

As wm had noted, in eonncMon with the light lig.itnie th.it the aiteiv 
aboie the bandage w.is distended .ind pulsated, not below it, so m the 
case of the model at ely tight band.ige on the contian. do we find that 
the veins below% nciei .iboio the fillet, swell and become dilated, whilst 
the aiteiies shiink, and such is the degiee of distension of the leins hcie 
that it IS only leiy stiong jnessuie that will foiic the blood hci ond the 
fillet, and cause any of the lenis in tlic ujipoi ])<uf of the .tun to use 

Fiom these facts it is easy foi eien eaiefnl obscnei to Icain that 
the blood enteis an extiemity by the aitcncs, foi when thov aio ellee- 
tualty compiessed nothing is dxnvn to the meinboi , the hand picscincs 
its eoloiu , nothing flow's into it, neither is it distended, hut when the 
piessiue IS diminished, as it is with the bleeding fillet, it is manifest that 
the blood is instantly thiowui in ivith foice foi then the band begins 
to swell, which is as much as to say, that w'hcii the aiteiies pulsate the 
blood IS flowing tluough them, as it is W'hen the modeiatch tight ligatuic is 
applied, but wheie they do not pulsate, as, w'licn a tight ligatiuc is used, 
they cease fiom ti aiismitting anything, they aie only distended .above 
the pait wdieie the ligatuze is .applied Idie veins .ag.ain being com- 
piessed, nothing can flow' tluough them, the ceitain indication of w'hicli 
IS, that below the ligatuie they aie mneli moio tumid than above it, and 
than they usually appeal wdien theie is no bandage upon the aim 

[ 50 ] 



It theiefoie plainly appeals that llic ligatuie pievenis the letiiin of 
the blood through the A^eiiis to the paits above i1, and maintains those 
beneath it in a stale of peiniaiient distension But the aiteiies, in spite 
of its piessuie, and undei the foiee and nnjiulse of the heait, send on 
the blood fioni the inteiual ])aits of the body to the pails beyond the 
bandage And heiein consists the difleience between the tight and the 
medium bandage, that the foimei not only pi events the passage of the 
blood 111 the veins, but in the aiteiies also, the lattei, howevci, whilst 
it does not pi event the pulsific foicc fiom extending beyond it, and so 
inopellmg ■f^lie blood to the extieniities of the body, conipi esses the veins, 
and gieatly oi altogethei impedes the letiiin of the blood thiough them 
Seeing, theiefoie, that the modeiately tight ligatuie lendeis the veins 
tuigid, and the whole hand full of blood, I ask, whence is this^ Does 
the blood accumulate below the ligatuic coming tliiough the veins, oi 
thiough the aiteiies, oi passing by ccitain seciet poles'^ Thiough the 
veins it cannot come, still less can it come by any system of invisible 
poies, it uust needs aiiive by the aiteiies, then, in confoimity with all 
that has Imeii alieady said That it cannot flow in bj^ the veins appeals 
plainly enough fiom the fact that the blood cannot be foiced towaids 
the lieait unless the ligatuie be lemoved, when on a sudden all the veins 
coUapse, and disgoigc themselves of their contents into the supeiioi 
paits, the hand at the same time lesuming its natuial pale coloui, — 
the tumefaction and the stagnating blood have disappeaied 
Moieovei, he whose aim oi wiist has thus been bound foi some little 
time with the medium bandage, so that it has not only got swollen and 
livid but cold, when the fillet is undone is awaie of something cold 
making its way iipwaids along with the letuining lilood, and leaehmg 
the elbow oi the axilla And I have myself been inclined to think that 
this cold blood using upivaids to the heait ivas the cause of the fainting 
that often occiiis aftei bloodletting fainting fiequently siipeivenes 
even in lobust subjects, and mostly at the moment of undoing the fillet, 
as the vulgai say, fiom the tuiiimg of the blood 
Faithei, Avhen we see the veins beloiv the ligatuie instantly swell up and 
become gorged, when fiom extieme tightness it is somewhat lelaxed, the 
arteiies meantime continuing unaffected, this is an obvious indication that 
the blood passes fiom the aiteries into the veins, and not fiom the veins 
into the aiteries, and that theie is eithei an anastomosis of the tivo oideis 
of vessels, oi poies in the flesh and solid parts geneialB^ that aie peim cable 
to the blood It is faithei an indication that the veins haiu fieqiient com- 
munications with one anothei, because they all become tiiigid togethei, 
whilst iiiidei the medium ligatuie applied above the elboiv, and li ani^ 
single small vein be piieked ivitli a lancet, they all speedily shiiiik, and 
disbuitheiiing themseh^es into this thej’" subside almost simultaneously 

[ 57 ] 



These consiclci aliens Mill enable .nn one 1o nndei stand the naline of 
the atliaelion lliat is exeiled In Iitr.iluies and ])ei(Iianee of fluxes gen- 
cially, hoM, ioi example, llie \(ins wlien (ominessed hi a handape of 
medium tig-htness ,i]i])lied alxne llie elliou llie blood cannot escape, 
Mdiilst, it still conlinnos to be dincn in to Mil b\ Hit foieinc poMci 
of the heait, bv mIucIi the jiails aie In iiuessits fillfd, croigcd Mith 
blood And Iiom should it be ollieiuise'’ Heat and pain and the fi? 
vacui diaM, indeed, but in such Mise onl\ tii.il ]iaits aie tilled not pic 
teinatiualh distended oi coiged, not so siiddeiih and Molenth oiei- 
M'helmed Mith the ehaiyc ol blood loieed in ujinn them that the flesh is 
laceiated .ind the vessels lujituHsl \othiiu: ol the Kind as an efieet of 
heat, Ol pain, oi the \aeuum foioe is eilhei tiediblo oi demonstiahle 
Besides, the liijatuie is eomjietdit to oci .ision llu' afflux in (piestion Mitli- 
out eithei pain, or lie.it oi ns rm in Weie lunii in .im Ma\ the cause 
hoM should it hai'pim that Mith the aim bound abuse the elboM the hand 
and fingeis should smcII beloM the banda’-re, and tluii \eins become dis- 
tended *2 The piessuic ol the bandaue feit.nnh ])ie\ents the blood fioni 
getting theie lu the seins And then uheiefoie is theie neifhci swelling 
noi leplction oi the \eins noi am sitru oi sMU]itom of atti action oi afflux, 
aboso the Iicatmc'? But this is the obsious lause ot the jneteinatuial at- 
tiaction and SMcllmg below the bandane and in the hand and fimieis, that 
the blood is entei ing abundanth and Mith loice but cannot pass out again 
Nom' is not this the cause of all tumefaction as indeed AMceima has it, 
and of all oppiessne icdundanes in ])aits that the access to them is open, 
but the egiess tioiii them is dosed'’ hence it (omes that thes .ue goigcd 
and tumefied And mas not the same thinir ha]i)icn in local inflamma- 
tions, M'lieie, so long as the SMelbncr is on the ineieasc, and has not 
leached its cxtieme teim, <i full pulse is felt in the pait esiieeiallv mIicii 
the disease is of tlie moie acute Kind and the swellimr usuallv tabes 
place most lapidly But those aie malteis toi aftei discussion Oi does 
this, which occuiiecl in inj omii case hapiieii fiom the same eaiise 
ThiOMm from a carnage upon one ooeasion, I stiuek im foieliead a bloM' 
upon the place Mdieie a tMug of the aitciy acB ances fiom the temple, and 
immediately, MUthin the time in mIiicIi tMcnty boats could base been 
made, I felt a tumoui the swe of an egg cles eloped, Mithout eithei heat 
Ol any gieat pain the neai Mcinitv of the aiteiv had caused the blood 
to be effused into the bruised pait Muth unusual foiee and quickness 
And noAv, too, we uiidei stand Mdiciefoic in phlebotomy Me apply oiii 
fillet aboye the pait that is punctuied, not beloM’- it, did the fioM come 
fiom above, not fiom beloM% the bandage in this case Mould not only be 
of no seivice, but Mmnld piove a positive hindeiance, it m'ouIcI have to 
be applied beloAv the oiifice, in oidei to have the floic moie fiee, did the 
blood descend by the xmiiis fiom supeiior to infeiior paits, but as it is 
elseAvheie forced tliioiigh the extieme aiteiies into the extieme Amins, 

[ 58 ] 



and the letmii in these last is opposed by the ligatiiie, so do they fill and 
swell, and being thus filled and distended, they aie made capable of 
piojectmg then chaigc with foice, and to a distance, when any of them 
IS suddenly piinctuied, but the fillet being slackened, and the letiiining 
channels thus left open, the blood foithwith no longei escapes, save 
by diops, and, as all the woild knows, if in peifoimmg phlebotomy the 
bandage be eithei slackened too much oi the limb be bound too tightly, 
the blood escapes without foice, because in the one case the letiiining 
ehannels aie not adequately olistiueted, in the othei the channels of 
iiifiux, the aiteiies, aie impeded 

CHAPTER XII 

THAT THERE IS A CIRCULATION OF THE BLOOD IS 
SHOWN FROM THE SECOND POSITION 
DEMONSTRATED 

If these things be so, anothei point which 1 have alieady lefeiied 
to, VIZ, the eontinua] passage oi the blood thiough the lieait, will also 
be confiimed We have seen, that the blood jiasses fiom the aitenes 
into the veins, not fiom the veins into the aiteiies, we have seen, faithei, 
that almost the whole of the blood may be withdiawn fiom a punctuie 
made in one of the cutaneous ^eins of the aim if a bandage propeily 
applied be used, we liave seen, still faithei, that the blood fiows so fieely 
and lapidly that not only is the whole quantity which was contained 
in the aim beyond the ligatuie, and befoie the punctuie was made, dis- 
chaiged, but the whole Avliich is contained in the body, both that of the 
aiteiies and that of the A'^eins 

Whence we must admit, fiist, that the blood is sent along with an 
impulse, and that it is uiged with foice beloiv the fillet, foi it escapes 
with foice, which foice it leeeives fiom the pulse and powei of the Iieait, 
for the force and motion of the blood aie deiived fiom the heait alone 
Second, that the afflux pioeeeds fiom the heait, and thiough the heait by a 
course from the gieat veins [into the aoita] , for it gets into the paits be- 
low the ligatuie thiough the aiteiies, not thiough the veins, and the 
aitenes nowheie leceive blood fiom the veins, nowheie lecewe blood save 
and except fiom the left ventiicle of the heart Noi could so laige a 
quantitj of blood be diaivn fiom one vein (a ligatuie having been duly 
applied), noi Avith such impetuosity, such leadiness, such celeiity, unless 
through the medium of the impelling poivei of the heait 

But if all things be as they aie now lepiesented, ive shall feel ourselves 
at libeity to calculate the quantity of the blood, and to leason on its 
ciieulai motion Should any one, foi instance, in peif mining phlebotomy, 
suffer the blood to flow in the mannei it usually does, ivitli foice and 
fieely, foi some half houi oi so, no question but that the greatest part of 

r ID] 



tlic l)lno(l 1)0111'^ ,ibsli,u‘l('(l, l.iinlniirs .md smicoix's onsno, niid tli.it 

not onh \soul(l tlio oiloiu's l)nl Iho •rJc.it Ncins ,ilso l)o n(‘.ii]\ ('mptied of 
Iheii oonlcnts It is onh consonanl willi UMson to (ondnde lliat in the 
com so ol the li.ilC lioni hinted at, so nnuii .is has cs(a]H>d hns also passed 
fioin the f>ica 1 ^CIns 1 ]iioup:li tlie lusiil into the .101 l,i And fuillici, if 
nc c.'ilenlale hon ni.iin ounces Ilou lhioii”:h one ,11111 01 liow main p.iss 
in t^\cnly 01 lhll 1 ^ ]nilsations nndci llie incdium Il^^ltnle, wc sh.ill Inne 
some gionnds toi cstnnatinir how much ]>asscs Ihimmli tiio othci aim 111 
the same sjiacc ol liiiic liow inmh ihioufirli hotli low ci c\ticmilics, how 
nnuh Ihioimh the neck on cilhci side, .ind IliiouLdi .ill the ollici .iitcncs 
.and Acins oi the I)od\, all oi whidi h.nc heen snjiplicd A\ifh ficsli blood, 
and as this blood nuisl li.nc* ji.nscd tlnoimli the hunts and \cntiiclcs of 
the heail, and innst ha\e tome tiom the <4U‘at \cins, — wc sh.ill poiccnc 
lliat .I ciKul.ilion IS .ibsolulch iickss.im, scciint Ih.il flic (pi.inlitics liinlcd 
.Tl cannot bo sn])])liod immcdi.itch lioni the nntcsl.i, .ind aic \.isth moic 
than can bo iciinisite toi the iimc nutiition oi tin* p.iits 

It IS still liiithci to be obs(i\cd that the tinths contended ioi aie somc- 
tnnos confiimcd in anotlici w.i\ . toi h.niiur tied ii]> the aim inopcih, and 
made the innulnic diih still il liom .il.iim 01 .nn olhei muses a state 
ol Jaintncss supcncncs, in wliidi the hc.iit .ilw.ns jnils.itcs 111010 l.iinrnidlv, 
the blood docs not (low liccK, but distils b\ dio]>s onh The icason is, 
(hat with the somcwh.it mc.itci th.in usual icsist.inco oficiod to the tiaiisit 
oL the blood bi the baud.iuc, (ouplcd with the wc.ikei .id 1011 of flic licait, 
and its diiiiiiiislied imiielliiiit jiowci, the stic.im (.iiinot iii.iKe its wai tiiidei 
the fillet , and laithci , ow 11m to the wc.ik and kimruishinii state of the hoait, 
the blood is not ti.iiisfei icd 111 sudi ^|U.lIltIt^ .is wont fiom the leins 
to the aitciies thioufih the sinuses of lh.it oifr.iii .'so also, and foi the 
same icasons, .110 the mcnstiual (luxes ol women, .ind indeed hcmoiihaccs 
of e^ely kind, conti oiled And now, a (onti.m state of things oc- 
cuiiing, the jiatieiif getting 1 id of ins fe.ii .iiid lecoAcniig Ins coinage 
the pulsihe powei is inci cased, the .11 tones begin again to beat with 
gieatei foice, and to dine the blood e\on into the ]i.iit that is hound, 
so that the blood nmv spiings fiom the piinctuie 111 the 1 cm, and flows 
111 a continiions sti cam 


CHAPTER XI n 

THE THIRD POSITION IS CONFIRMED AND THE 
CIRCULATION OF THE BLOOD IS 
DEMONSTRATED FROM IT 

Tims fai we have spoken of the quantity of blood ])assing thioiigh the 
heait and the lungs 111 the eentie of the bodj'', and in like mannei fiom 
the aiteiies into the veins in the iieiipheial ptiits and the body at laige 
We have yet to explain, howevei, in wdiat mannei the blood finds its 

[GO] 



waj’' back lo the lieait from the extremities by the veins, and how and in 
V hat way these ai e the only vessels that convey the blood from the ex- 
ternal to the cential paits, which done, I conceive that the thiee funda- 
mental piopositions laid down foi the circulation of the blood will be 
so plain, so well established, so obiioiisty true, that they may claim 
geneial credence Now the lemaining position will be made sufficiently 
deal fiom the vahes wliidi aie found in the cavities of the veins them- 
selves, f 10111 the uses of these, and from expeiiments cognizable by the 
senses 

The celebiated llieionvmus Palnieius ot Aquapendente, a most skilful 
anatomist, and leneiable old man, oi, as the learned Riolan will have 
it. Jacobus Sylvius, fiist gave lepieseiitations of the valves m the veins, 
winch consist ot laised oi loose poitions of the inner meinbranes of these 
vessels, of extieme delicacy, and a sigmoid oi semilunai shape They aie 
situated at diffeicnt distances iioin one anothei, and diversely in different 
individuals, they aie connate at the sides of the veins, they are directed 
upwaids 01 towaids the trunks of the veins, the two — foi there aie for 
the most pait two togethei — legaid each othei, mutually touch, and aie so 
ready to come into contact b}^ then edges, that if anything attempt to 
pass from the tiuiiks into the blanches of the veins, or from the greater 
vessels into the less, they completely pi event it, they are faithei so ar- 
laiiged, that the hoi ns of those that succeed aie opposite the middle of 
the convexity ot those that pieeede, and so on alternately 
The discoveiei of these valves did not lightly undei stand their use, nor 
have succeeding anatomists added anything to oui knowledge foi then 
office IS by no means explained when we aie told that it is to hinder 
the blood, by its weight, from all flowing into infeiior paits, for the 
edges of the valves in the jugulai veins hang downwaids, and aie so con- 
tiived that they prevent the blood fiom rising upwaids, the valves, 
in a woid, do not invaiiably look upwards, but always towards the 
ti links of the veins, invaiiably towaids the seat of the heart I, and in- 
deed others, have sometimes found valves in the emulgent veins, and in 
those of the mesenteiy, the edges of which weie directed towaids the 
vena cava and vena portae Let it be added that there are no valves in 
the aiteiies [save at then roots], and that dogs, oxen, etc, have in- 
variably valves at the divisions of their ciuial veins, m the veins that 
meet towaids the top of the os sacium, and in those blanches which 
come fiom the haunches, in which no such effect of gravity fiom the 
erect position was to be apprehended Neither are theie valves in the 
Ougulai veins foi the pin pose of guaiding against apoplexy, as some have 
said, because m sleep the head is moie apt to be influenced by the con- 
tents of the carotid aiteiies Neither are the valves piesent, m order 
that the blood may be retained m the divarications oi smaller trunks 
and minuter bianelies, and not to be suffered to flow entirely into the 

[611 



moic open and ca]),ieions eliannels, foi llie\ occui ^^ll(■le llioic aic no 
dnaiications, .dtlu)up:h il nnisl ])o owtud lliat 1lu‘^ ,iio most ficqucnl at 
the i)oinls ^\ 1)01 e ))ianc*]i('s loin Noillioi do !li(“\ o\is) Joi Ihc pin pose of 
lendeiing tlie cuiienl of Ijlood inoie •'Ion fioiii the cenlio of llie lioclv, 
for it seems likely that the blood \\onld bo disiiosod to flow with sufficient 
slowmess of its own acooid, as it would ha\o to jiass fioin laigei into 
continiialh sniallci scssols, beniir scpai.itod fioni the mass .ind fountain 
head, and attaining fiom waimei into (oldoi jihues 

But the ^al\es aie soloh made and inslilulod lost the blood should pass 
fiom the gieatei into the lessci \eiiis, .iiid eithei luiituie them oi cause 
them to become \aiicose, lost, instead <»i ad\anoing fiom the e\ticme to 
the cential jiaits of the bods, the blood should lathei piocccd along the 
seins fiom the centie to the cxtiomitios, but the delicate sahes, while 
thes^ leadih open in the light diieition, eiitiioh luoseiit all stioli contian 
motion, being so situated .md aiiangod, that it .iin thing escapes, oi is 
less peifeetly ohstiuctcd bs the coinu.i of the one ahose the fluid pass- 
ing, as it sseie, bj’ the chinks between the coimia, it is immediately le- 
eened on the cons exits of the one beneath, ssliich is placed tiaiisseisely 
ssith icfeicncc to the foiinoi, and so is efieitualls hindeicd fiom getting 
any faithci 

And this I base fiequcntls expciienoed in ms dissections of the sems 
if I attempted to pass a piobe fiom the tiiink of the scins into one of 
the smalloi blanches, ssh.itesci caie I took I found it impossihle to in- 
tioduce it fai any svas, bs le.ison of the s.ilses, sshilst, on the contiaiy, 
it ssms most eass' to push it along in the opjiosite diicction, fiom without 
inssmids, oi fiom the blanches tossaids the tiuiiks and loots In mans 
places tssm smlses aic so placed and fitted, that sshen laised they conic 
exactlj^ togethci in the middle of the sein, and aie theie united by the 
contact of then maigins, and so acciuate is the adaptation, that neither 
by the eye noi by any othei means of examination can the slightest chink 
along the line of contact be peiceised But if the piobe be noss' intio- 
duced fiom the exticmc toss'aids the moie cential paits, the s’^alscs, like 
the floodgates of a iis’-ei, gism ssxnj'^, and aie most leadilj^ pushed aside 
The effect of this aiiangement plainly is to pies^ent all motion of the 
blood from the lieait and vena casm, ssdiethei it be upsvaids tossxaids the 
head, or dossmwmids tosvaids the feet, or to eithei side towmids the aims, 
not a drop can pass, all motion of the blood, beginning in the laigei 
and tending towaids the smallei veins, is opposed and lesisted by them, 
w^hilst the motion that pioceeds fiom the lessei to end in the laigei 
branches is favonied, oi, at all events, a fiee and open passage is left 
for it 

But that this truth may be made the moie appaient, let an aim be 
tied up above the elbow as if foi phlebotomy (A, A, Pig 1) At inteivals 
in the couise of the veins, esiiecially in labouiing iieoiile and those whose 

[62] 



'ij 


5i9lH=SS‘SSj^H# 

«ie nnge^, above th ^^ein jJ^’ 0 

»«- L“"*' Z:Z: (o' «1 "e® i?"‘ 

® chore a of 

»«'/ /X. IT, ™o ■‘'aJve n 


L 


‘Ms 


M 




r 






\ \,f 


Jl, 






?:t?,- wik'- 


cFia 






ZZTy ZZlTtZ Zb T ^ZlrZ7‘"‘* *'-‘=o’tie 

“ ®ffle as (f'fo'-o appear t), 1®’ “ ''“'oiv 7 

'noBeem.,,. 5®‘ of t J , “ ‘ie funrf,„ “o ''alve 

«‘o '>food°4a!“ ‘*““0 aad p„j«®0'd vaiv« « tte 

*«eBde/’ f " beiag 17!, ’ ‘° »ove«t 1 7 oob,. 

r/- a? te'lT aBd , 

foaj *-^01 stream 



up^\alds bc^oncl the no\l \al\c (N), -son ^\lll ])cic(m\o lli.it lliis poition 
of the vein continues einptv (L N), .ind tli.il the blood e.innol lolio^nadc, 
pieciscly as ^^c ha\e ahoadv seen the ease to be in ^’lt^ 2, but the fin"ci 
fiist applied (II, Kig 2, L, h’lp: *1), beinu ieiiio\(>d, iininedi.iteh the i cm 
IS filled fiom bclo\\, and the aim beeoiiies .is it .ipiieais .it 1) C, Fi" 3 
That the blood in the ^Olns Iheiofoie juoeeeds iioiii inlenoi oi iiioie lo- 
mote to supeiioi ]i.iils, and low.uds the lie.iil mo\nm in these \ossels m 
this and not in the eontian diiedion, ajiiie.iis most ob\iousl\ And al- 
though in some places the \al\es. In not .lelinir with siuli ])eifcct ac- 
cuiacv, 01 i\hcic theie is but a simile s.ihe do not seem tot.ilh to pieicnt 
the passage of the blood iioiii the eentie, still the gie.it ei niimbei of them 












plainly do so, and then, wheic things appeal contincd inoic negligcntb, 
this IS compensated eithei bi the inoie ficquent occiuionee oi inoie peifcct 
action of the succeeding valves oi in some othei i\av the iciiis, in shoit, as 
they aie the fiee and open conduits of the blood ictuining fo the heait, 
so aie they effectually iii evented fiom selling as its channels of distiibii- 
tion fi om the heait 

But this othei eiicumstance has to be noted The aim being bound, 
and the veins made tiiigid, and the valves piominent, as befoie, apply 
the thumb oi fingei ovei a vein in the situation of one of the valves 
in such a way as to eompiess it, and pi event any blood fiom passing 
upwaids fiom the hand, then, with a fingei of the othei hand, stieak the 



blood m the vein npwaids till it has passed the next valve above, the 
vessel now remains empty, but the fingei being lemoved for an instant, 
the vein is immediately filled fiom below, apply the fingei again, and 
having in the same manner streaked the blood upwards, again lemove 
the finger below, and again the vessel becomes distended as befoie, and 
this lejieat, say a thousand times, in a shoit space of time And now 
compute the quantity of blood which yon have thus piessed up beyond 
the valve, and then multiplying the assumed quantity by one thousand, 
you will find that so much blood has passed thiough a eeitain iioition 
of the vessel, and I do now believe that you will find youiself con- 
vinced of the enculation of the blood, and of its lapid motion But if 
111 this expel imeiit you say that a violence is done to iiatuie, I do not 
doubt but that, if you pioeeed in the same way, only taking as great 
a length of vein as possible, and meiely lemaik with what lapidity the 
blood flows upwaids, and fills the vessel fiom below, you will come to the 
same conclusion 

CHAPTER XIV 

CONCLUSION OF TEE DEMONSTRATION OF THE 

CIRCULATION 

And now I may be allowed to give in biief my view of the circulation 
of the blood, and to propose it foi geneial adoption 

Since all things, both argument and ocular demonstration, show that 
the blood passes thiough the lungs and heart by the action of the [auricles 
and] ventiicles, and is sent for distiibution to all parts of the body, where 
it makes its way into the veins and poies of the flesh, and then flows by the 
veins from the ciieumfeience on every side to the centre, from the lesser 
to the gieatei veins, and is by them finally discharged into the vena cava 
and right aiiiicle of the heart, and this in such a quantity or in such a 
flux and reflux thither by the arteries, hither by the veins, as cannot 
possibly be supplied by the ingesta, and is much greater than can be 
required for mere purposes of nutrition, it is absolutely necessary to con- 
clude that the blood in the animal body is impelled in a circle, and is in a 
state of ceaseless motion, that this is the act or function which the heart 
performs by means of its pulse , and that it is the sole and only end of the 
motion and contraction of the heart 

CHAPTER XV 

THE CIRCULATION OF THE BLOOD IS FURTHER 
CONFIRMED BY PROBABLE REASONS 

It will not be foreign to the subject if I here show further, from certain 
familiar leasoiiiiigs, that the circulation is matter both of conveiiieiice and 
necessity In the first place, since death is a corruption which takes place 

[ 65 ] 



thiough deficiency of Jicnt* and since .ill Ininj? limits aic y.nni, all djing 
Ihiiigs cold, llieie must bo a p.iificul.ii seal <ind founl.nn, ,i bind of home 
.and licailli, ylieic llie clicnsliei ol n.iliuc, the oiigin.il of the nalnc file, 
IS stoicd .iiid piesei\ed, a\ hence hc.il .ind lile .iic dispensed to all p.ails as 
fioin ,i founlain head, whence susfen.incc ni.n be domed, .ind upon which 
concoction and null il ion, and all \egel.ilne eneigv iii.Tv depend Now, 
that the hcail is this jihice, that the hc.iit is the luineiplc of life, and that 
all passes in the maiinci pisf monlioiied, ] tiusf no one will dein 

The blood, thcietoie, lefpiucd to h.ne motion, .ind iiuhcd siuh a motion 
that it should ictiiin ag.iin to the he.ut, foi sent to llic extoinal paits of 
the body lai fiom its fountain, .is Aiistolle sa\s and without motion, it 
w'ould become congealed Foi we see motion 'rcnci.itiiig and Keeping tip 
heat and spiiits undci all ciicuinstanccs, and lest .illowing them to escape 
and be dissipated The blood, theiefoie, beeoine thick oi coinxcalcd by the 
cold of the cxticmc .iiul out waul jiaits and loblied of its spiiils, pist as 
it IS in the dead, it was impei.it nc that fiom its lount .ind oiiirin, it should 
again iccenc heat and spiiils, and .ill else leiiuisite to its piescn.ition — 
that, b^ letuining, it should be ieno\.iled and icstnicd 

AYe fiequently sec how the exticmities aic chilled b\ tiie e\tein.il cold, 
how the nose and cheeks and hands look blue, .ind how tlic blood, stagnat- 
ing in them as in the pendent oi lowei paits ot a eoipse becomes of a 
duskj' hue, the limbs .it the same time getting toipid, so that thc\ can 
seaicely be mowed, and seem almost to Inne lost then Mt.ilitv Now tlle^ 
can by no means be so cffcetuallv, and csjiccialh so specdih lestored to 
heat and coloui and life, as In a new afilux .ind ajipulsion ol heat fiom its 
souice But how can paits attiact in wliicli the heat .uul life aie .almost 
extinct^ Ol how should they whose pass.iges aic filled with condensed 
and fiigid blood, admit ficsh aliment — lcno^ated blood — unless thei had 
fiist got rid of then old contents^ Unless the heait wcic liuly that foun- 
tain Avheic life and heat arc lestoied to the lefiigei.ited fiuid, and whence 
new blood, waim, imbued with siniits, being sent out b^ the aitciies, tliat 
wdiicli has become cooled and eftete is foiccd on, and all tlio p.iiticles le- 
cover their heat wdiich was failing, and then Mtal stimulus well-nigh 
exhausted 

Hence it is that if the heait be unaffected, life and health may be le- 
stored to almost all the othei paits of the bodj’-, but the lieait being chilled, 
or smitten with any seiious disease, it seems mattei of necessity that the 
wdiole animal fabiie should suffei and fall into decay When the souiee 
is coiiupted, theie is nothing, as Aiistotle s.ns,- which can be of seiMce 
either to it oi aught that depends on it And hence, by the w\ay, it mai 
perchance be wherefore giief, and love, and envy, and anxiety, and all 
affections of the mind of a siinilai kind aie accompanied witli emaciation 
and decay, or with cacoehemj^ and ciuditj’, wdiieli eiigendci all mannei of 

^Aristotle’s De Respiratione lib ii ot lii Do Pai t Animal ot alibi 

-De Part Animal in 

[CC] 



diseases and consume the body oi man For every affection of the mind 
that IS attended with eithei pain oi pleasiiie, hope oi feai, is the cause of 
an agitation whose iiifiueiice extends to the heart, and there nr duces change 
from the natural constitution, nr the temperature, the pulse and the rest, 
which impairing all nutrition in its source and abating the powers at large, 
it IS no wonder that various forms of incurable disease in the extremities 
and 111 the trunk are the consequence, inasmuch as in such circumstances 
the whole body labours under the effects of vitiated nutrition and a want 
of native heat 

Moieover, when we see that all animals live through food concocted in 
then interior, it is imperative that the digestion and distribution be per- 
fect, and, as a consequence, that there be a place and receptacle where 
the aliment is peifected and whence it is distributed to the several mem- 
beis Now this place is the heart, for it is the only organ of the body 
which contains blood for the general use, all the others receive it merely 
for their peculiar or private advantage, oust as the heart also has a 
supply for its orvn especial behoof nr its coronary veins and arteries, 
but it IS of the store which the heart contains iii its auricles and ven- 
tricles that I here speak, and then the heart is the only organ which is so 
situated and constituted that it can distribute the blood in due pro- 
portion to the several parts of the body, the quantity sent to each being 
according to the dimensions of the artery which supplies it, the heart 
serving as a magazine or fountain ready to meet its demands 

Further, a certain impulse or force, as well as an impeller or forcer, 
such as the heart, was requiied to effect this distribution and motion of 
the blood, both because the blood is disposed from slight causes, such as 
cold, alarm, horror, and the like, to collect in its source, to concentrate 
like parts to a whole, oi the drops of water spilt upon a table to the 
mass of liquid, and then because it is forced from the capillary veins into 
the smaller ramifications, and from these into the larger trunks by the 
motion of the extremities and the compression of the muscles generally 
The blood is thus more disposed to move from the circumference to the 
centre than m the opposite direction, were there even no valves to oppose 
its motion , whence that it may leave its source and enter more confined 
and colder channels, and flow against the direction to which it spon- 
taneously inclines, the blood requires both force and an impelling power 
Now such IS the heart and the heait alone, and that in the way and 
manner already explained 


[ 67 ] 



ciiAmni XVI 


THE CIRCULATION OF THE RLOOI) IS FURTHER 
PROVED FROM CERTAIN CONSEQUENCES 


Theio aic still coit.nn phenomena, ^\hlell, taken as eonseiinenccs of tins 
Until assumed as pioicm, aie not without then use in exciting: belief, as it 
iveie, a j^ostci lO ) and wliieli, althoutrh tlies iinix seem to he iinohed in 
much doubt and obsduitx, nexeitheless le.idih .idinit of liaxiin' icasoiis 
and causes assnined loi them The ])henomena alluded to aic those that 
picscnt thcmsches in (onnexion with eonlamons, jioisoned wounds, the 
bites ol sei]ients and i.ibid anim.ils, lues xeiieiea and the like AVc some- 
times see the whole sxstein < oiit.iminated, thoufih the pail ^ll^l infected 
lemains sound, the lues \eneiea has oee.isionallx made its attack with 
pains 111 the shouldeis and head, and olhei sxmiitoms, the genital oigans 
being all the while iinafteeted, and then we know that the wound made 
bj the labid dog liaxing healed, lexei and a ti.iin ol disastious sxmptoms 
nexeitheless supeixene ^Vhenee it ajijHMis that the (ontagion iinpicsscd 
upon 01 deposited in a paituulai pait is bx .iiid bx earned bx the ict inn- 
ing ciuicnt of blood to the lieait, and bx tliat oiir.in is sent to contaniinato 
the XX hole bodx 

In teitian icxoi, the moibifie <ause seeking the lieait in the fust instance, 
and hanging about the hoait and lungs lendcl^ the iiatient shoi Iw iiidcd, 
disposed to sighing, indisjioscd to exoition, because the xital luinciple is 
oppiesscd and the blood lovced into the lungs and lendeied thick, does not 
pass thiough then substance (as I haxe nix sell seen in opening the bodies 
of those XX ho had died in the beginning ol the attack), xxhen the pulse is 
alxxajs fieciuenl, small, and oceasionallx iiiegulai , but the heat inci easing, 
the maltei becoming attenuated, the passages ioicecl, and the tiansit made, 
the XX hole bodx begins to use in tcmpciatuie, and the pulse becomes fullei, 
stiongei — the fcbiilc paioxxsin is lullx foiined xxhilst the pictcinatnial 
heat kindled in the lieait, is thence diflnsed bx the aiteiies thiough the 
xxdiole body along with the moibific niattei, xxhieJi is in tins wax ox ci come 
and dissolx'ed bj natiiie 

When xx'c peiceixe, fiiithci, that nicdicmcs applied cxteinallx exeit then 
influence on the body iiist as if thex' had been taken inteinallx, the tiuth 
xx’’e aie contending foi is eonfiimcd Colocxuith and aloes [applied ex- 
ternally] mox’^e the bellx% canthaiides excites the uiine, gailic applied 
to the soles of the feet assists exiiectoiation, coi dials stieiigthen, and an 
infinite numbei of examples of the same kind might be cited It xxill not, 
theiefore, be found iinieasonable peichance, if w'e say that the x'eiiis, bx 
means of then oiifiees, absoib some of the things that aie applied exteinally 
and cany this iiwaids xxnth the blood, not otheixxuse, it may be, than those 
of the mesenteiy imbibe the chyle fioin the intestines and cany it mixed 
xvith the blood to the livei Poi the blood enteniig the mesenteij by the 

[6S] 



eoeliac aitery, and tlie snpeiioi and inferior mesenteiics, proceeds to the 
intestines, from winch, along with the chyle that has been attracted into 
the veins, it re tin ns by their numerous lamifieations into the vena portae 
of the liver, and fioin this into the vena cava, and this in such wise that 
the blood in these veins has the same colour and consistency as in othei 
veins, ill opposition to what maiij'- believe to be the fact Nor indeed can 
we imagine two contiary motions in any capillary system — the chyle up- 
wards, the blood downwaids This could scarcely take place, and must 
be held as altogether impiobable But is not the thing lathei aiianged 
as it IS by the consummate providence of natuie'^ Foi weie the chyle 
mingled with the blood, the crude with the concocted, in equal pioportions, 
the lesult would not be concoction, transmutation, and sanguification, but 
rather, and because they aie severally active and passive, a mixtuie or 
combination, oi medium compound of the two, piecisely as happens when 
mile is mixed with water and syrup But when a veiy minute quantity of 
chjde IS mingled with a very large quantity of cii dilating blood, a quantity 
of chyle that bears no kind of propoition to the mass of blood, the effect 
is the same, as Aiistotle says, as when a diop of water is added to a cask 
of wine, 01 the contrary, the mass does not then piesent itself as a mixtuie, 
but IS still sensibly either wine or watei So in the niesenteiic veins of an 
animal we do not find eithei chyme oi chyle and blood, blended together 
or distinct, but only blood, the same in colour, consistency, and other sen- 
sible piopeities, as it appears in the veins generally Still as theie is a 
certain though small and inappieciable pioportion of chyle or uneon- 
cocted matter mingled with this blood, natuie has interposed the liver, 
in whose meandering channels it suffers delay and undergoes additional 
change, lest ai riving piematurely and crude at the heait, it should 
oppress the vital piineiple Hence in the einbiyo, there is almost no 
use for the livei, but the umbilical vein passes directly through, a 
foramen oi anastomosis existing from the vena portae, so that the blood 
1 etui ns from the intestines of the foetus, not thiough the livei, but into 
the umbilical vein mentioned, and flows at once into the heait, mingled 
with the natuial blood which is returning fiom the placenta, whence 
also it IS that in the development of the foetus the liver is one of the 
oigans that is last foimed, I have observed all the members perfectly 
marked out in the human foetus, even the genital organs, whilst theie 
was yet seaicely any tiace of the livei And indeed at the peiiod when 
all the parts, like the heart itself in the beginning, aie still white, and 
save 111 the veins theie is no appeal ance of ledness, you shall see nothing 
in the seat of the livei but a shapeless collection, as it weie, of ex- 
tiavasated blood, which you might take foi the effects of a contusion oi 
luptuied vein 

But in the incubated egg theie aie, as it ivere, tiro umbilical vessels, 
one fiom the albumen passing entiie thiough the livei, and 

[6al 


going 



straight to the lieail, anotliei fioin llic >olIc, ending in the \cna poilac, 
foi it appeals that the chick, in Iho fust insl.uicc, is cnliich foiined and 
iioiuished bj" the A\hilc, but In llic velk aflei it lias come to peifcction and 
IS excluded fioin tlie shell, foi this pail nun slill be found in the abdomen 
of the cheek luanj' da^s aftei its exclusion, ,ind is a substitute for the milk 
to other annuals 

But these inattcis mil be bettei spoken of in nn obsoi\alions on the 
foimation of the foetus, nheic mam piopositions, the following among 
the numbei, will be discussed Wheicfoic is this pait foiincd oi peifeeted 
fiist, that last”? — and of the se\eial niombeis wh.it pait is the cause of 
anothei’ And mam jioints Inning special icfeicncc to the lieait, such 
as ‘Wheiefoie docs it hist aequiic consistciun, and .ijiiieai to possess life, 
motion, sense, bcfoie am othci pait of the bod\ is peifeeted? as Aiistotlc 
says in his thud book, Dc Pa)tjl)u<f Anvnnhum And so ,ilso of the blood 
Wheiefoie does it piecedc all the icst? And in what wa\ docs it possess 
the vital and animal piineiple? And show a tendenev to motion, and to 
be impelled hitliei and thithei, the end foi which the lieait appeals to be 
made? In the same wa's, in considenng the pulse Wheiefoie one kind 
of pulse should indicate death, anothei icco\en ? And so of all the othei 
lands of pulse, what ina-s be the cause and indication of each So also in 
the consideiation of ciises and natuial ciitical discharges, of nutiition, and 
especially the distiibution of the nutiimenl, and of dctluxions of e^cr^ 
desciiption Finally, ictlecting on c\cn jiait of medicine, plnsiolog^, 
pathology, scmeioties, thcrapouties, when I sec how mam questions can be 
answeied, how' mail} doubts lesohcd, how much obscuiit\ illustiated. In 
the tiuth we have declaicd, the light we ha\c made to shine, I see a field 
of such vast extent in which I might piocced so fai, and expatiate so 
wndel}'', that this my tiactate would not only swell out into a Aolumc, whicli 
was beyond my puipose, but iiiv whole life, peicliancc, would not suffice 
for its completion 

In this place, theiefoie, and that indeed in a single chaptei, I shall 
only endeavoui to icfei the vaiious paiticulais that piesent themselves m 
the dissection of the heait and ai tones to then seveial uses and causes, 
for so I shall meet wnth many things which leceivc light fiom the tiuth I 
have been contending foi, and wdiich, in then tuiii, rendei it moie ob- 
vious And indeed I Avould have it confiimed and illustiated by anatomical 
arguments above all othei s 

There is but a single point wdiich indeed would be moie coiiectly placed 
among our obseivatioiis on the use of the spleen, but wdiich it wull not be 
altogether impertinent to notice in this place incidentally Fiom the 
splenic branch which passes into the jiancieas, and fiom the iippei pait, 
arise the posteiior coionar}’’, gastiie, and gastioepiploic veins, all of wdiich 
aie distributed upon the stomach in numeious blanches and twugs, just as 
the mesenteric vessels aie upon the intestines, in like mannei, fiom the 

[ 70 ] 



infeiior pait of the same splenic biaiicli, and along the back of the colon 
and lectuni pioceed the hemoiihoidal veins The blood letuinmg by these 
veins, and bunging the ciudei juices along with it, on the one hand fiom 
the stomach, where they aie thin, watery, and not yet perfectly chy lifted, 
on the other thick and moie eaithy, as derived from the faeces, but all 
poured into this splenic blanch, are duly tempered by the admixture of 
coiitraiies, and nature mingling together these two kinds of juices, difficult 
of coction by reason of most opposite defects, and then diluting them with 
a large quantity of warm blood (for we see that the quantity returned 
from the spleen must be very large when we contemplate the size of its 
aiteiies), they are brought to the porta of the liver in a state of higher 
preparation, the defects of either extreme are supplied and compensated 
by this arrangement of the veins 

CHAPTER XVII 

THE MOTION AND CIRCULATION OF THE BLOOD ARE 
CONFIRMED FROM THE PARTICULARS APPARENT 
IN THE STRUCTURE OF THE HEART, AND FROM 
THOSE THINGS WHICH DISSECTION 
UNFOLDS 

I do not find the heart as a distinct and sepaiate part m all animals, 
some indeed, such as the zoophytes, have no heart, this is because these 
animals are coldest, of no great bulk, of soft texture or of a certain uni- 
form sameness or simplicity of structure, among the number I may in- 
stance grubs and earthworms, and those that are engendered of putrefac- 
tion and do not preserve their species These have no heart, as not re- 
quiring any impeller of nourishment into the extreme parts , for they have 
bodies which are connate and homogeneous, and without limbs, so that 
by the contraction and relaxation of the whole body they assume and ex- 
pel, move and remove the aliment Oysters, mussels, sponges, and the 
whole genus of zoophytes or plant-animals have no heart, for the whole 
body IS used as a heart, or the whole animal is a heart In a great number 
of ammals, almost the whole tribe of insects, we cannot see distmctly by 
reason of the smallness of the body, still in bees, flies, hornets, and the 
like, we can perceive something pulsating with the help of a magnifying 
glass, in pediculi, also, the same thing may be seen, and as the body is 
transparent, the passage of food through the intestines, like a black spot or 
stain, may be perceived by the aid of the same magnifying glass 
In some of the bloodless^ and colder animals, further, as in snails, 
whelks, shrimps, and shell-fish, there is a part which pulsates — a kind of 
vesicle or auricle without a heart — ^slowly indeed, and not to be perceived 
save in the warmer season of the year In these creatures this part is so 

U e , not having red blood [Willis 1847] 

C713 



conliivcd Ih.il il sliall ])nls.ilc‘, .is Ihcie is liou' ji n('C('ssil\ foi some im- 
pulse to clistiibulc the mitntno fluid 1 )\ ifs'isoii ol llip ■\.inel\ of oigaiuc 
paits, 01 of the deusilA ol ilic suhsl.incc, hut llio ]uiIs,i(ioiis oeciu infie- 
quently, aud someliincs in fonsoquonce ol llu* (old not <il .ill, an an.ingc- 
meiit the host adapted 1 o llicin as heing ol .1 doiihifiil ii.itiiio, so that some 
times they appeal to Ine someliincs lo die, soniolimes lliei slion the m- 
talily of an animal, sonicl lines of .1 \ (‘gel able This seems .ilso (0 he the 
case with the insects -wliuh eonce.il tlieinsehes in winlei, and lie, as it ^\cle, 
defunct, 01 nieich manifesting a Kind of ^ogel,lll\c oMstcncc But 
whethci the s.iine thing happens in llie ease of eeilain animals tlmt haie 
led blood, such as fiogs, toiloises, sei penis, swallous, ni.n be made a 
question uil bout am Kind of impiojiiieh 

In all the laigei ,tnd u.iiiiiei, bcc.iiise fied-] blooded .iniin.ils, tlieic ^\as 
need of an impellci ol Iho nuliilne fluid, .ind th.it ])eiehanee possessing 
a consideiable ainoiint ol ]io\\ei In fishes, seijienls, li/.iuls, toitoiscs, 
flogs, and otheis of the s.iine Kind Iheie is a heail pieseni, fmnished •with 
both an auiiclc and a ^entlIcle, wliencc it is jieileelh tine, as Aiistotlc 
has obsci\ed,' Ih.il no [led-] blooded .inini.il is uilhoul a hoail, In the 
impelling ponei of nliioh Ihe nutiitne fluid is ioieed, both nith gioatci 
vigoui and lapiditi to a gieatci distaiuc it is not meielv agitated In an 
auiicle as it is in lonei ioiins And then in icg.iul to .inimals that aic 
jet laigei, naimei, and inoie peilcel, as tlun .iboiind in hlood, nhich is 
evei liottei and inoic spiutuous, and possess bodies of gicalei sii^c .and 
consistency, thci lequiic a laigei, sliongci, .ind nioic flcsln he.iit, m oidei 
that the nutiitnc fluid nun be piopellcd mill ACt gie.itci foicc .and 
celeiitj’’ And iuilhei, inasinueh as the inoie jieilect animals leqiiiic a 
still moie peifeet nuliitioii, and a laigei siqiph of n.itnc heat, in oidei 
that the aliment maj^ be thoioughh concoct cd and acqune the last degiee 
of peifection, thej^ lequiied both lungs and a second lentiiclc, uhich 
should foice the nutiitive fluid thiough them 

Eveij^ animal that has lungs has thciefoie tno ^entllcles to its heait, 
one right, and anotliei left, and Avhcie\ci theic is a light, also is theie a 
left ventiicle, but the contiaij’^ of this does not hold good ■\\heie theie 
is a left theie is not ahvaj^s a light ventiicle The loft Aentiicle I call that 
winch IS distinct in office, not 111 jilace fiom the othei, that one immely 
which distiibutes the blood to the bodj’- at laige, not to the lungs only 
Hence the left ventiicle seems to foim the piincipal jiait of the heait, 
situated m the middle, moie stioiigly maiked, and eonsliucted with gi eatei 
care, the heait seems foimed foi the sake of the left ventiicle, and the 
light but to minister to it, foi the light neithei leaehes to the apex of the 
heart, 1101 is it nearly of such stiength, being tliiee times thiiinei m its 
walls, and in some soit jointed on to the left, (as Aiistotle saj"s,) though 


me Part Animal , lib in 


[ 72 ] 



indeed it is of sieatei capacity, iiiasmneli as it lias not only to supply ma- 
te! lal to tlie left ventiicle, but likewise to fuinisli aliment to the lungs 

It IS to be obseived, however, that all this is otlieiwise m the embryo, 
wheie theie is not such a difference between the two ventiicles, but as in 
a double nut, they aie neaily equal m all i aspects, the apex of the light 
leaching to the apex of the left, so that the heait piesents itself as a sort 
of double-pointed cone And this is so, because in the foetus, as already 
said, Avhilst the blood is not passing thiough the lungs from the light to the 
left cavities of the heait, but flowing by the foiamen ovale and ductus 
aiteiiosus, dnectly fiom the vena cava into the aoita, whence it is dis- 
tiibuted to the vdiole body, both ventiicles have in fact the same office to 
perfoim, Aidience then equality of constitution It is only Avhen the lungs 
come to be used, and it is lequisite that the passages indicated should be 
blocked up, that the diffeience in point of stiength and othei things between 
the tivo ventiicles begins to be apparent in the altered cii cumstances the 
light has only to throw the blood thiough the lungs, whilst the left has to 
impel it through the whole body 

There aie fuither within the heart numerous braces, so to speak, fleshj^ 
columns and fibrous bands, Avhich Aiistotle, in his third book on Kespira- 
tion, and the Parts of Animals, entitles nerves These are variously ex- 
tended, and are either distinct or contained in grooves in the Avails and 
partition, Avheie they occasion numerous pits or depressions They con- 
stitute a kind of small muscles, Avhieli are superadded and supplementary 
to the heart, assisting it to execute a more powerful and perfect contrac- 
tion, and so proving subservient to the complete expulsion of the blood 
They are in some sort like the elaborate and artful arrangement of ropes in 
a ship, bracing the heart on every side as it contiaets, and so enabling it 
more effectually and forcibly to expel the charge of blood from its ven- 
tricles This much is plain, at all events, that some animals have them 
strongly marked, others have them less so , and, in all that have them, they 
are more numerous and stronger in the left than in the right ventricle, 
and Avhilst some have them in the left, there are yet none present in the 
right ventricle In the human subject, again, these fleshj'- columns and 
braces are more numerous in the left than in the right ventricle, and they 
are more abundant in the Amntricles than nr the auricles, occasionally, in- 
deed, in the auricles there appear to be none present whatsoever In large, 
more muscular and hardier bodies, as of countrymen, they are numerous, 
nr more slender frames and in females thej’' are feAvei 

In those animals nr AAdrrch the ventricles of the heart are smooth Avithin, 
and entirely Avithout fibres or muscular bands, or an Aching like foA’^eae, as 
in almost all the smaller birds, the partridge and the common foAAd, ser- 
pents, flogs, tortoises, and also fishes, for the major part, there are no 
chordae tendinae, nor bundles of fibres, neither are there any tiieuspid 
valves in the ventiicles 


[ 73 ] 



Some animals have the ii^lit \cnlnc'l(' smoolli inleinallv, but the left 
piovided -with fibions bands, sucb as Ibe ironse, swan, .ind laigoi buds, 
and the leason hcie is still the same as olsewlu’ie as the lungs ,ne spongy 
and loose, and soil, no gicat .imount oL lou-o is loipinod to ioiee the blood 
through them, hence the light Ncnlinlc is eithoi without the bundles in 
question, oi the^ aie fcwci and weaKei, not so /lesln oi like nuisclas, those 
of the left vcntiiclc, howe\ei, <iio both stionmu .ind moie iiiimcious, inoie 
fleshy and muscnlai, beiause the lell \entii(h* lequiies to be siiomici, in- 
asmuch as the blood wliidi il ])iopels h.is to be dincn Ihiough the whole 
body And this, too, is the le.ison win llie lolt \enlnele occupies the 
middle of the lieail, and h.is ]iaiietes thiee limes llnclcci and sliongci than 
those oi the light llcme all animals — and among men it is not othei- 
wise — that aic endowed with jiailKul.iih stioiiir liaiiies, and that liaie 
laige and flesln limbs at .1 gioat dislanee iioni the lieait, h.nc this ecutial 
oigan of giealci thickness, sliength, and imiscul.iiil\ And this is both 
obvious and nccessaiv Those, on llie eonli.in, that .iie ol sotfci and moic 
slendei make liaie the hc.iit moie fl.iccid, soltei, and inteinalh cittiei 
spaielj’ 01 not at all fibious Considei i.iithei the use ol the seicial lahes, 
wdiich aie all so auangcd, that the blood once iccencd into the ^entiiclcs 
of the heait shall neiei icguigitate, once foiccd into the puhnonan aiten 
and aoita shall not flow back upon the ^cntlIcles When the \al\cs aic 
laised and bi ought togethei the% foim <1 thicc coiiieicd line, such as is 
left by the bite of a leech, and the moie the,^ aie foiced, the moie fiimh 
do they oppose the passage of blood The tiicuspid \ahcs aie placed, 
like gate-keepeis, at the entiancc into the ^cntllclcs liom the ^enae cavae 
and pulmonai^ veins, lest the blood when most foiciblv impelled should 
flow back, and it is foi this icasoii that thej aie not found in all animals, 
neithei do thej’ appeal to have been constiuctcd with equal caie in all the 
animals in wdiich they aie found, m some thc^ aie moie accuiateh fitted, 
in others moie lemisslj’’ 01 caiclcssly contincd and ah\avs w’lth a Aiew to 
their being closed undei a gieatci 01 a slight ei foice of the ventiicle In 
the left ventiicle, theiefoic, and in oidei that the occlusion may be the 
moie perfect against the gieatei impulse, tlicie aie only two vahes, like a 
mitie, and pioduced into an elongated cone, so that thej come togethei 
and touch to their middle, a ciicuinstance wdiich peihaps led Aiistotle 
into the eiioi of supposing this ventiicle to be double, the division taking 
place transveisely Foi the same leason, indeed, and that the blood may 
not leguigitate upon the pulmonaiy veins, and thus the foice of the 
ventricle in piopellmg the blood thiough the system at laige come to be 
neutialized, it is that these mitial valves excel those of the light ventiicle 
in size and strength, and exactness of closing Hence, too, it is essential 
that there can be no heait wnthout a ventiicle, since tins must be the sonice 
and storehouse of the blood The same law’^ does not hold good in lef- 
erenee to the biain Foi almost no genus of buds has a ventiicle in the 

[ 74 ] 



biain, as is obvious in the goose and swan, the biains of which neaily equal 
that of a rabbit in size, now labbits have ventricles in the brain, whilst the 
goose has none In like mannei, wheievei the heart has a single ventricle, 
theie IS an auiicle appended, flaccid, meinbianous, hollow, fllled with blood, 
and wheie there aie two ventiieles, there are likewise two auricles On 
the other hand, howevei, some animals have an auricle without any ven- 
tricle , 01 at all events they have a sac analogous to an auricle , or the vein 
itself dilated at a particular pait, perfoims pulsations, as is seen in hornets, 
hees, and other insects, which ceitain experiments of my own enable me to 
demonstrate have not only a pulse, but a respiration in that part which is 
called the tail, whence it is that this part is elongated and contracted now 
moie laiely, now more fiequently, as the cieature appears to be blown and 
to requiie a largei quantity of air But of these things, moie in oui 
Treatise on Respiration 

It IS in like manner evident that the auricles pulsate, contract, as I have 
said before, and throw the blood into the ventricles , so that wherever there 
IS a ventricle an auricle is necessary, not merely that it may serve, ac- 
cording to the general belief, as a source and magazine for the blood for 
what were the use of its pulsations had it nothing to do save to contain'^ 
No, the auricles are prime movers of the blood, especially the light auricle, 
which IS “the flrst to live, the last to die,” as already said, whence they 
are subservient to sending the blood into the ventricle, which, contracting 
incontinently, more readily and forcibly expels the blood already in mo- 
tion, just as the ball-player can strike the ball more forcibly and further 
if he takes it on the rebound than if he simply threw it Moreover, and 
contrary to the general opinion, since neither the heart noi anything else 
can dilate or distend itself so as to diaw aught into its cavity during the 
diastole, unless, like a sponge, it has been flrst compressed, and as it is re- 
turning to its primary condition, but in animals all local motion proceeds 
from, and has its original in the contraction of some part it is conse- 
quently hy the contraction of the auricles that the blood is thrown into the 
ventricles, as I have already shown, and from thence, by the contraction of 
the ventricles, it is propelled and distributed Which truth concerning 
local motions, and how the immediate moving organ in every motion of 
an animal primarily endowed with a motive spirit (as Aiistotle has it^) is 
contiactile , and how Aristotle was\cquainted rvith the muscles, and did not 
unadvisedlv refer all motion in animals to the nerves, or to the contractile 
element, and therefore called those little bands in the heart nerves — all 
this, if I am permitted to proceed in my purpose of making a particular 
demonstiation of the organs of motion in animals from observations in my 
possession, I tiust I shall be able to make sufficiently plain 

But that we may go on with the subject we have in hand, viz , the use 
of the auricles in filling the ventricles we should expect tliat the more 

’In the book De Spintu and else-^vhere 

[ 75 ] 



dcn&e and coinpael Ihc lic.ut the thukoi its p.u iclcs, tlio stioiifroi ami nioie 
immcular must be liu' auimlc to louc and fill it, and \uu \c)sa tins 
IS actually so in some Ibe auiiele piesents itseli as a saimumolent \csicle, 
as a ilim mcmbianc conlannm? lilood, as in fislies, in uliieh the sac that 
stands in lieu oi the auricle, is of such dclicaci and ample capaciti, that 
it seems to be suspended oi to float abtnc the hcait , in tliosc fishes iii nliieli 
the sac is somenhat moic flcsln, as in the csiip, baibel. temh, and otlicis, 
it bcais a nondeilui and stiong icscmblance to the luntzs 

In some men of stuulioi Jiame ,ind sfoutoi m.ilvc the niflit .uiiitle is so 
stioiig, and so eunoiisli (onstiueled nitliiii ol li.iiids -iml i.inoiish mtci 
lacing fibios, tlml it seems to eipial the lenlnele oi the heail in oihei 
subjects, and I must sai that I am ,ist<niished to find such dncisiti m 
this paiticulai in difieienl nidnidnals It is to bo oliseiied, lioweioi, tliat 
in the foetus the aunelcs aic out ol .ill jnoiioition huge, nhieh is boeaiiso 
thei aic piesent beloic the iicait [the leiiliieiilai jiorfion] makes its .np 
peaiance 02 sufTiecs loi its office e\en nhtn it h.is .pipeaied, .nul l!ic\ tbcic- 
fore ha\e, as it neic the dut\ oi the uhole heait committed to them, .is lias 
alreadi been dcmonsti.ited But iih.il I h.iie obsened m the foiinatioii 
oi the foetus as beloie icm.uked (.ind Aiistotle had .ihc.uh confuincd all 
in slndiing the inciih.iled egg) tliions the luealesl bylil and likelihood 
upon the point Whilst tlic ioetns is set in the muse oi .1 soft noun, 01, as 
IS eommonlA said, in tlic milk, theio is a meie bloods jioint 01 pulsating 
vesicle, a poilion apiinicntbs ol the umhiheal sein, dilated .it its coinmcncc- 
ment 01 base, In and b\, when the onthne oi the ioetns is distmeth in- 
dicated, and it begins to base gieatoi bodih consistence, the \csielc in 
question Inuing become 11101 c llcsln and stiongci, and changed its position, 
passes into the aiuiclcs, o\ci 01 upon which the hods ot the hcait begins 
to spiont, though as set it ajip.uentls peiioinis no duts , hut when the 
foetus IS faithci adsaiiccd, when the hones can he distinguished fiom 
the soft pails, and inovcmeiits t.ikc ]ilaee, then it lias also a hcait ni- 
teinatelv ssdiich pulsates, and, as I base said, Ihiows blood bs eitlici scii- 
tncle fiom the sena cava into the ailciies 

Thus natiiie, cs'ci pcilcel and desinc, doing nothing in sain, h.is ncithei 
gis’-en a lieait ssdicic it ss'as not rcqiiiicd, noi pioduccd it hoioie its office 
had become neccssars , but bv the same stages 111 the desclopment of eseiv 
animal, passing thiough the constitutions oi all, as I mas sas (osum, woini, 
foetus), it aequiies peifcclioii in each These points ssill he loiind clse- 
svlieie confiimed bs mimeioiis obsci stations on the foimation ot the foetus 

Finally, it svas not svithoiit good gioiiiids that Ilippociatcs, in lus hook, 
Be Cot de, intitles it as a muscle, as its action is the same, so is its function, 
VIZ, to coiitiact and move something else, in tins case, the cliaige of the 
blood 

Paitliei, as 111 muscles at laige, so can sve infer the action and use oi 
the lieait from the aiiangement of its fibios and its genei.il stiuctuic All 

[ 70 ] 



anatomists admit with Galen that the body of the heart is made up of 
various courses of fibres rumiing straight, obliquely, and transversely, with 
reference to one another, but m a lieait which has been boiled the arrange- 
ment of the fibres is seen to be difeerent all the fibres in the parietes and 
septum are circular, as in the sphiireters, those, again, which are in the 
columnae extend lengthwise, and are oblique longitudinally, and so it 
comes to pass, that when all the fibres contract simultaneously, the apex 
of the cone is pulled towards its base by the columnae, the walls are drawn 
circularly together into a globe, the whole heart in short is contracted, 
and the ventricles narrowed , it is therefore impossible not to perceive that, 
as the action of the organ is so plainly contraction, its function is to propel 
the blood into the arteries 

Nor are we the less to agree with Aristotle in regard to the sovereignty 
of the heart, nor are we to inquire whether it receives sense and motion 
from the brain ^ whether blood from the liver ^ whether it be the origin 
of the veins and of the blood ^ and more of the same description They 
who affirm these propositions against Aristotle, overlook, or do not rightly 
understand the piincipal argument, to the effect that the heart is the first 
part which exists, and that it contains vuthin itself blood, life, sensation, 
motion, before either the biain or the liver were in being, or had appeared 
distinctly, or, at all events, before they could perform any function The 
heart, ready furnished with its proper organs of motion, like a kind of 
internal creature, is of a date anterior to the body first formed, nature 
willed that it should afterwards fashion, nourish, preserve, complete the 
entire animal, as its rvoik and dwelling place the heait, like the prince 
in a kingdom, in whose hands lie the chief and highest authority, rules 
over all, it is the original and foundation from which all power is derived, 
on which all power depends nr the animal body 
And many things having reference to the arteries farther illustrate and 
confirm this truth Wiry does not the arteria venosa pulsate, seeing that it 
IS numbered among the arteries^ Or wherefore is there a pulse in the 
vena arteriosa^ Because the pulse of the arteries is derived from the im- 
pulse of the blood Why does an artery differ so much from a vein in the 
thickness and strength of its coats ^ Because it sustains the shock of the 
impelling heart and sti earning blood Hence, as perfect natuie does noth- 
ing in vain, and suffices under all circumstances, we find that the nearer the 
arteries are to the heart, the more do they differ from the veins in struc- 
ture, here they are both stronger and more ligamentous, whilst in extreme 
parts of the body, such as the feet and hands, the biain, the mesentery, and 
the testicles, the two orders of vessels are so much alike that it is impossible 
to distinguish between them with the eye Now this is for the following 
verv sufficient reasons for the inoie remote vessels are from the heart, 
nitli so much tlie less force are they impinged upon by the stroke of the 

[ 77 ] 



licaii, ^\hlch IS biokcn In the fiical dislaiifo at wincli it is gnen Adel to 
this, that tlie impulse of tlie lieail exeited uiion the mass of lilood, Mhieli 
must needs fill the tiunks and hianelies oi the .nteiie.s, is duelled, dnidcd, 
as it Mere, .ind diminished at e\ei\ siihduisioii , so tli.il the ultimate capil- 
laiy divisions oi the ai tones look like \eiiis, ,ind this not morclv m eoii- 
stitution hut 111 fuiielioii, Joi tlun haieeilhei no peueptihle pulse, oi lliej 
laiely cxhihit one, .iiid iic\er s.ue uhen- the heait heats moic Molcnth 
than uoiit, oi at a jiail vlieic tin minute \essel is moic dikitod oi open 
than elseuheie nonec it hajipeiis that ,it times ue aie awaie of a pulse 
in the teeth, in infiainmatoi \ tumouis, and in the fin^eis, at anothoi tunc 
ye feel nothing: ol the soil lienee too. In this single sniiptom I ha\c 
ascertained foi eeilain that \ouiiir peisons, whose pulses aic natuiallj 
rapid, weic labounng iindei fe\ei , in liice maiinei, on eompiessmg the 
fiiigeis in joulliful and dclnate suliietts dining a fchiile paiowsm, I ha^e 
leadily perccued the jnilse theie On the othci hand, \sheii the hcait 
pulsates moic languidh, it is oilen impossible to feel the }nilsc not morclv 
in the fingeis, hut at the wiisf, ,md e\en at the tem])le, this is the ease m 
peisons aftlicted with lipotlnmiae .nul asplusia. and Insteiical sMiiptoms, 
as also in peisons ol iei\ weak ((institution .md in the monhund 

And licie surgeons aie to he ad\ised that, when the blood escapes with 
foiee in the amputation of limbs, in the lenunal of tuniois, and m wounds, 
it constantly comes Irom an aiten , not alw.us jiei sallum, howeiei, be- 
cause the smalloi aitcnes do not jnilsatc cspeeialh if a touiniquct has 
been applied 

And then the leason is the same wlicicfoie the pulmonan aiten has 
not only the stiucluic of an ailon, hut wheicfoic it does not dillei so 
wadely in the tlnckncss of its tunics liom tlie \oins as the aoila the aoita 
sustains a moie powerful shock iiom the lett \cnlnele than the pulmonan 
arteiy does from tlie light , and the tunics of this last ^esscl aic tlnnnci 
and softer than those ol the aoita in the same piopoition as the walls of 
the light ventiiele of the licait aic wcakci and Ihinnoi than those of the 
left ventiiele, and in like mannoi, in the same dcgioc in whicli the lungs 
are softei and la\ci in stiuetiiic than the fiosh and othci constituents of 
the body at laige, do the tnnies oi the blanches of the pulmonaiv aitcn 
differ fioin the tunics of the vessels deiucd fiom the aorta And the 
same piopoition in these seicral paiticulais is nnncisallv picsoiNcd The 
moie museulai and pow'eiful men aic, the fiiinei then flesh, the stiongei, 
thicker, denser, and inoie fibioiis their heait, in the same pio])oition aie 
the amides and arieiies in all icspcels thicker, closer, and stiongei And 
again, and on the othei hand, in those animals the ^entllcles of whose heait 
are smooth wnthin, wathout villi oi lalves, and the walls of wdiidi aie thin- 
nei, as in fishes, seipeiits, buds, and veiy many geneia of animals, in all 
of them the aiteiies diffei little oi nothing in the thickness of then coats 
fiom the veins 

E7S] 



Paither, the leason Min- the liinss liave such ample vessels, both aiteiics 
and ^ems (foi the capacitv oi the pulmonaiv veins exceeds that oi both 
the eimal and ^ugnlai Aessels), and A\hv thev contain so laige a quantitv 
of blood, as bv experience and oeulai inspection ive laiov thev do, ad- 
monished of the fact indeed bv Aiistotle, and not led into eiror bv the 
appearances found in animals vhich have been bled to death, — is, because 
the blood has its fountain and stoiehouse and the 'woikshop of its last 
peifection in the heart and lungs AVhy, in the same vay ive find in 
the eouise of oui anatomical dissections the aiteiia veiiosa and left 
ventiicle so full of blood, of the same black colour and clotted eharactei 
too, as that vith vhicli the light ^cntllcle and pulmonaiv aiteiv aie filled 
inasmuch as the blood is incessantlv passing fiom one side of the heait to 
the othei thiough the lungs Wheiefoie, in fine, the pulmonaiy arteiv 
01 vena aiteiiosa has the constitution of an aiteiv, the pulmonaiv veins 
01 aiteiiae lenosae have the structuie of leins, because, in sooth, in func- 
tion and constitution, and eveivtlnng else, the fiist is an aiteiv, the otheis 
are veins, in opposition to vhat is commonlv belieied, and ivhv the pul- 
monarv arterv has so laige an oiifice, because it tianspoits much moic 
blood than is lequisite for the iiutiition of the lungs 
All these appeaiances, and manv otheis, to be noted in the couise of 
dissection, if light Iv veighed, seem cleailv to illustiate and fullv to confirm 
the tiiilh contended foi tlnoughout these pages, and at the same time to 
stand 111 opposition to the lulgai opinion, foi it Mould be leiv difficult to 
explain in any othei vav to M'hat puipose all is constiucted and airanged 
as M"e have seen it to lie 


C7e] 




1640 

PIERRE GASSENDI 

A BRIEF NOTE UPON A DEMONSTRATION OF THE 
EXISTENCE OF THE FORAMEN OVALE 
IN THE ADULT 




PIEERE GASSENDI 


(Courtesy Zeitschrift fUr cUe ges.mte Naturwissenschaft ) 



PIERRE GASSENDI 

(1592^1655) 

✓^lEERE GASSENDI was bom at Cbamptercier, near Digne, in Provence, France 
oC His uncle, the cure of Champtercier, noticed that Gassendi had a remarkable 
ability for learning, and through his efforts Gassendi was sent to the college at 
Digne When he was nineteen years of age, Gassendi matriculated at the University 
at Aix, where he studied philosophy under Fesaye A year later (1612) he was re- 
called to the college at Digne to lecture on theology In 1616 he received the degree 
of Doctor of Theology at Avignon and in the following year he was ordained Fol- 
lowing the acceptance of holy orders, he was invited to the University at Aix to 
occupy the chair of philosophy, which he accepted 

At Aix he became interested in anatomy, physics, and astronomy, and he once 
remarked that he frequently observed dissections in the anatomic amphitheater at 
Aix He became more and more critical of the pedagogic reliance on the orthodox 
Anstotelio-scholastic teachings, and for this reason, presumably, he was asked to 
leave Aix in 1622 He next became a canon at Grenoble In 1624: at Grenoble was 
published his ‘ ‘Exercitationes paradoxicae adversus Aristoteleos ’ ’ This quarto vol- 
ume contamed his several arguments against the teachings of Aristotle 

In 1625, Gassendi was appointed to be provost of the Cathedral of Digne, but the 
appointment was not confirmed until 1634 During the interim he traveled first to 
Pans and later to Flanders and Holland During these years he published attacks 
against Robert Fludd, the English physician who expounded mystical philosophy 
From 1641 to 1646 in a senes of writmgs he quarreled with Descartes regarding 
his metaphysical conceptions 

Through the influence of Richelieu, Gassendi was appomted by Louis XIV to the 
chair of mathematics in the College Royal While he was in Pans, Gassendi became 
interested in Epicurean philosophy and later published three works on this subject 
Gassendi suffered from a disease of the thorax and in 1648 left Pans to seek a 
milder climate in southern France In 1653, he returned to Pans but his health 
did not improve and after interminable bleedmgs by his physicians he died on 
October 24, 1655 

In 1640, Gassendi had published, in a volume (by himself and three other authors) 
entitled “De foetus formatione,” a brief note on a demonstration of the existence 
of the vestigial foramen ovale in the adult This was not Gassendi’s discovery but 
merely a note or report of an anatomic dissection he had witnessed durmg his pro- 
fessorship at Aix It IS, however, an observation of great moment, and because the 
question of the perviousness of the septum of the heart was an important anatomic 
consideration vitally necessary to the establishment of the fact of the circulation of 
the blood, we have chosen to reproduce it 



A NICE OBSERVATION OF THE PERVIOUSNESS 
OF THE SEPTUM OF THE HEART 

By 

PETER GASSENDI 

I SHALL closcnhe I nnsolf lia\e swii 

^Ylnlc 1 \\as lesitlnuj; m Ai\, \slu'nc\(>i a tioii was lieni" pei- 
foimecl 1 was ])icsont fiequcnlh ni llio analoimcal .iinplullicatie Now 
foi mam ^cals I had ohsencd )man.d)l\ flial dissoctois, laKing the 
heait in their liaiids, would test the pemousness of its septum with a 
blunt instiuinent wliieli t]le^ call .i sp.itula, .ind would conclude, as 
phjsicians ha\c concluded that the ti.insinission of blood fiom the light 
chambei to the left must oceui In insensible ti .msud.ition 

Now when this pioblem eamc to bo discussed b\ the piofessois of 
anatomv, eight se<us <igo, theic came among the disputants a diligent 
siugeon, Pas anus bs name, who wanted to demonstiate to us onloohcis 
that the facts weie otlieiwise So, taKiinr iij) the sjiatula, lie undcifook to 
penetiale the mediastinum oi the heait But he did not attempt to push 
the instillment stiaight thiough, as the othcis had done, but liaMiig ni- 
tiodueed its tip (foi the tissue of the septum jnesents a thousand little open- 
ings) pushed onwaid with utmost gentleness, tuining the nistiument with 
the gieatest patience up and down and fiom side to side, seeking alwass a 
faithei ingiess And at last the nistiument w.is seen ciiteimg the left 
chambei But then, because we alleged that he had made an aitificial open- 
ing, he hinisclt lequested one ot us to incise the septum down to his instill- 
ment, wnth a sliaip scalpel When the incision had been made we found 
that no tissue ani wdiere had been ni.iuicd, and we saw that only the meatus, 
or canal, notwnthstanding the tact that it was a veil winding passage, was 
lined wnth a very thin and glistening membiane 
These, then, me the passages winch I mentioned to Fludd (who acknowl- 
edged cleaily that he had been ignorant of then exist ence too) , and I said 
that since they leally do exist they cannot be wothoul some function, and 
theiefoie it should be evident lliat theie is a leal peicolation of blood 
fiom the light chambei into the left And I maintained that the aitciial 
blood wms deiived in this wmy 

*Elegans do septo coidts peivio ohseivatio, 1C40 Tianslatccl bj G Kasten Tallmaclge 
Bull Hist Med 7 429-457 19S9 



Indeed, it seems piobable that the moie subtle pait of the blood is, so 
to speak, sucked thiough tins septum, oi foiced tlnough by compiession 
But the grossei pait of the blood, with the heavy vapouis winch it contains, 
enters the patent pulmoiiaiy arteiy and peivades and nouiishes the tissues 
of the lungs Then, aftei expiiation has earned off the heavy bieath and 
the heavy vapouis, the moie subtle residue of this blood is gathered into 
the pulmonary vein so that, together with the puiei air which was inhaled 
in bieathmg, it may flow into the left ventricle, either drop bj’- drop, as the 
geneial notion says it must, oi in laige spuits, as Harvey’s opinion seems 
to have it 


[S5] 




1661 

MARCELLO MALPIGHI 
ON THE CAPILLARIES 




MARCELLO MALPIGHI 
Portrait by unknown artist 


(Courtesy Charles C Thomas) 





MARCELLO MALPIGHI 

(1628 1694 ) 

“I see With my eyes, a great, certain thing ” 

— ^Malpiglu, parapluasmg Homei 

CTTI^AECELLO MALPIGHI is generally referred to as being the first histologist 
CyVC The better to understand his several contributions to this subject, especially 
his discovery of the capillaries, mention should be made of the development of the 
compound microscope, on which his and the subsequent discoveries of his followers 
depended 

According to Henker,i there is reason to believe that the magnifymg power of 
transparent media having convex surfaces was known very early, because a convex 
lens of rock crystal was found by Layard among the rums of the palace at Nimrud 
Seneca also described hollow spheres of glass filled with water as being commonly 
used for magnifiers The perfect gem cutting of the ancients could not have been 
attained without the use of magnifiers, and it can be assumed that these artificers 
made their own magnifiers Convex glass lenses were first generally used to assist 
ordinary vision as spectacles The spectacle-makers were not only the first to pro- 
duce glass magmfiers, but they were also the inventors of the telescope and the 
compound microscope During the Thirty Years’ War (1618-1648) the simple micro- 
scope was widely known, and Descartes in his “Dioptrique,” published in 1637, 
described microscopes wherem a concave mirror was used in connection with a 
lens for illuminatmg the object Antony van. Leeuwenhoek (1632-1723), who added 
to Malpighi’s initial description of the capillaries, appears to be the first to succeed 
in grmding and polishing lenses of such short focus and perfect figure as to render 
to the simple microscope a better object 

The early opticians contended that a compound microscope — ^that is, one havmg 
two lenses so that small objects can be magnified — ^would never produce images 
as good as those viewed by means of an instrument of the simple type, but this 
contention has proved to be erroneous* Although the simple microscope may be 
improved, it has relatively feeble powers of magnification, and to obtain stronger 
magnifications the compound form is necessary 

Soon after the discovery of the telescope, the compound microscope was in- 
vented The inventors were probably the Middelburg lens-gnnders, Johann and 
Zachanas Janssen, the time, about 1590 The microscope had a negative eyepiece 
It was not greatly improved until 1646, when Fontana described a microscope which 
had a positive eyepiece This produced much better images and was, most likely, 
the type of apparatus that Malpighi worked with With it, he was able to describe 
the capillary circulation, the existence of which Harvey, because of his inferior 
equipment, was able only to postulate 

Marcello Malpighi was bom at Crevalcuore, near Bologna He was the son of 
well-to-do parents In 1645 he entered the University of Bologna as a student of 
philosophy He was forced to interrupt his studies in 1649 because of the sudden 
deaths of his father, mother, and his father’s mother Being the eldest son of the 


’Henker Otto Micioscope, The Encj clopaedia Britannica, ed 11, \ol 18, pp 392-407 

[SO] 


family, he was called upon to make settlement of the c&tatc This was rendered 
dimcult hy icason of a dispute conccmlng houndarics sshich had arisen between 
his family and the jiosscssors of an adjoining jiroportj, the family of Sbaraglia 
This dispute continued to the end of Malpighi’s da\s and was a constant source of 
irritation The Sbaraglia family not onlj brought political pressure to boar to 
obstruct professorial appointments, but also prliatclj heckled Malpighi and his wife 
It was not until 1G51 that Malpighi resumed his studies, this time with the idea 
of studying medicine One of his professors, Bartolommeo Massati, to disKcniinate the 
new work of Harvey and the new learning of the English philosophers, occasionallj 
gathcied some of the instnictois and more mature students at his home This group 
eventually formed itself into a club, limited its membership to nine, the number 
of the Muses, and adopted the name, "Conis aiiatomicus ” Stimulated bj Harvey's 
new viewpoint of learning bj means of actual observation, nicrabors of this club 
not only met for discussion but soon were dissecting bodies and experimenting 
on living animals Young Malpighi was soon admitted to the club, and therein 
learned the foundations for his future work He was making remarkable progress 
in his studies and in 1G53 achieved his doctorate in medicine and philosophj 
In 1651 Malpighi nianricd Francesca, the sister of his leanicd professor, Massan 
She bore him no children In 1G5G hlalpighi, who had been biisj in medical practice, 
obtained a chair at the Unlvcrsitv of Bologna and was made a professor of medicine 
Meanwhile, in the same year, Ferdinand II Grand Duke of Tuscany, ofTered him a 
post in theoretical medicine at the University of Pisa hfalplghi accepted the offer 
and for three years taught at Pisa There, under the guidance of Duke Ferdmand, 
a brilliant intellectual activity was stimulated and sincere efforts were made by the 
entire staff at the university to broaden the bonds of natural knowledge 

It was at Pisa that Malpighi met Giovanni Borelli and much was to come of their 
friendship, which lasted manv years Borelli also had conic to the university in 1656 
to fill the position of professor of mathematics at the request of Duke Ferdinand 
Borelli was twenty years Malpighi’s senior and taught him the new mathematics and 
physics of the school of Galileo Malpighi reciprocated and interested Borelli in 
anatomic and biologic problems to such an extent that soon Borelli was combining 
his mathematic talents in the study of the phenomena of living things Borelli’s 
great work, “Do motu aninialium,” published after his death (1680 or 1681) shows 
the influence of Malpighi Although in later years Malpighi’s private life was 
embittered by the coarse personal attacks of Borelli, they remained close friends 
for many years Whenever a new idea occurred to Malpighi or whenever he made 
a new discovery, he always desired Borelli ’s opinion regarding it 

In 1659, because of some difiicultics regarding the paternal estates, Malpighi 
resigned his post at Pisa and returned to Bologna There he was again appointed 
professor of medicine, and iii 1660 he was able to announce privately to Borelli, in 
two letters, his discovery of the stnicture of the lung These two letters were 
printed in 1661 and constituted Malpighi's fiist published work In these bnef 
epistles, two discovenes of fundamental importance were announced In the first 
letter he described the vesicular nature of the lung, showing how the divisions of 
the trachea terminated in the dilated air vesicles Ho was the first, therefore, to 
supply an anatomic basis for the tnie conception of the respiratory process 

The second letter contained the first obseivation of the capillanes and supplied 
the missing link in the rationale of the circulation of the blood Without the aid of 
a microscope, Haivey had discovered and pioved the existence of the circulation He 
had further predicted the possibility “that m the limbs and extreme parts of the 
body the blood passes either immediately by anastomosis from the artenes into the 

[90] 



veins or mediately from the pores of the flesh, or in both ways ” Malpighi, by 
histologic demonstration, proved the existence of capillary anastomosis between the 
arteries and veins 

In 1665, in a little tract, “De omento pinguedine, et adiposis ductibus,” Malpighi 
came upon another discovery concerning the blood, the demonstration of the red 
corpuscles This he failed to interpret properly Under the microscope he observed 
flat red cells in the mesenteric blood vessels of the hedgehog Apparently, he mis- 
took the red blood corpuscles for globules of fat passing from fatty tissues into the 
current of the blood This observation was later clarified by van Leeuwenhoek 
who, in 1674 in the “Philosophical Transactions” of the Eoyal Society, gave the 
first accurate description of the red corpuscles 

Besides discovering the capillaries and being the first to observe, if not to 
describe accurately, the red blood corpuscles, Malpighi worked unceasingly on the 
structure of the glands and glandular organs He is also regarded as the founder 
of descriptive embryology, because of his investigations of the chick embryo He 
also discovered the “rete mucosum” or the Malpighian layer of the skin and further 
proved that the papillae of the tongue are organs of taste (G-amson, p 255) 

In his monumental work on the structure of the viscera (“De viscerum structura, 
Exercitatio anatomica,” published at Bonn in 1666), Malpighi did much to advance 
the understanding of the physiology of the liver, spleen, and kidneys In this 
volume, moreover, is contained the first account of the general enlargement of the 
lymphatic vessels with nodules in the spleen, more fully described by Thomas 
Hodgkin in 1832 During his later years, Malpighi spent much of his time in re- 
searches on the anatomy of the silkworm and the morphology of plants, in which 
latter endeavor he is ectually famous in association with his researches in physiology 
In 1684, he had a great misfortune His house in Bologna burned His microscopes 
were ruined and many of his precious manuscripts were destroyed 

In 1691, the new pope. Innocent XII, invited Malpighi to come to Eome as his 
personal physician He at first refused, but after bemg urged by the pontiff, 
Malpighi, being an old friend, accepted He continued to work in that capacity, but 
soon after his arrival at Eome he became ill In July 1694, he suffered a mild 
apoplectic attack and on November 28th he suffered a second attack On the follow- 
ing day he passed away 


[ 91 ] 



EPISTLE II —ABOUT THE LUNGS1 

To that ver^ famous ami learned Man 

ALPHONSUS BORELLIUS 

Celebrated Professor of Science at Pisa 

By 

MARCELLUS MALPIGHIUS 

Professor of Medicine at Bologna 

T here llns .uul o])s(mit\ to bo met uith m iiatmal things, 

that thcic seems to be soinellimg m tlicin that is not to be dctciiniiied 
altogethci In oui senses And so, stcadfnsth woiKing nith \en gieat 
laboui, ^\e ina\ coiitemiil.ito Naluic showing lieisell in hei boKinnings, as 
it were in a \olumc claboiatod thiointh nustciies And when we ti.\ to 
nniavel the obscuic things in the Msceia ol animals, at lengtli b\ oiii 
eft'oits, and oiilv with gieal we.iijiiess, we eoncliKle that the tiutli of oiii 
obseivations is made out We boiiow illiimination, as if bv dcgiees, fioni 
dissection, sometimes of insects, sometimes ol pcileet animals Foi Natme 
IS accustomed to iclicai'sc with ceitain laige, ])erhaps basei, and all classes 
of wnld (animals), and to place in the impel feet the ludiments of the 
perfect animals 

And now% most famous man, I will handle the niattei moie closoh Thci'' 
w'ere tw'o things wdiicli, in my epistle about obsenation on the lungs, I left 
as doubtful and to be investigated with moie exact stud\ 

(1) The first was wdiat may be the nctwoik dcseiibed thciein, wheie cei- 
tain bladders and sinuses aie bound together in a ceilain wa^ in the lungs 
(2) The other wms whethei the tcsscIs of the lungs aie connected hi 
mutual anastomosis, oi gape into the common substance of the lungs and 
sinuses 

The solution of these problems may piepaie the waj for gi eater things 
and will place the opeiations of Natme moie clearly befoie the eves Poi 
the unloosing of these laiots I have destioj’-ed almost the wdiolc race of fiogs, 
which does not happen in that savage Batrachomyoniachia of Homei Eoi 

•In his second letter to Borellius, Malpiehl describes his discovery of the capillarj 
circulation — F A W , 1940 

fVe puhnomhus obsej vationes anatotniae Bologna 1G61 Tianslated bj James Voung' 
MD, Proc Koy Soc Med (Part I) 28 7-11, 1929-1930 

[ 92 ] 



in the anatomy of frogs, which, by favour of my veiy excellent colleague, 
D Caiolo Fracassato, I had set on foot in oidei to become moie certain 
about the membianous substance of the lungs, it happened to me to see 
such things that not undeseivedly I can better make use of that (saying) 
of Homei for the present matter — 

“ I see with my eyes a woik trusty and great ’ ’ 

Foi in this (frog anatomy), owing to the simplicity of the stiuctuie, and 
the almost complete transparency of the vessels which admits the eye into 
the interior, things are more eleaily shown, so that they will bung the 
light to otliei mere obscviie matters 

o 



Tabula I 

Fig I Outermost piece of dried lung showing the rete 

Fig II Interior vesicles and sinuses sketched with portion of the interstitium in the 
upper part The beginning and complete prolongation could not be exhibited to the 
eye by the picture 

Fig III Adaptation over the trachea and the pulmonary \essels vhich also, parted 
from their usual site, are shown for easier understanding 

In the flog, theiefoie, the abdomen being laid open leiigtlmise, the lungs, 
adheiing on each side to the lieait, come foith They aie not slack as in 
othei animals, but lemaiii tense foi the animal’s lequiiements They 
aie nothnig moie than a membianous bladdei, vhich at fiist sight seems 
to be spatteied with veij' small spots, aiianged in oidei aftei the fashion 
of the skin of the dogfish — commonly called Sagiino In foim and surface 
plot libel ances it lesembles the cone of a puie liut inteinallv and ex- 
teinallv a ceitain textuie of vessels dneiselv piolonged rs connected to- 

[ 93 ] 



gelhoi, \\luch, 1)\ Ihc puKo, In conli.in ino\c'mciit, ami the luseilion of the 
\cni, aic puImonal.^ ai tones In the eonea\e and inteiioi pait of this 
(bladder) d almost Aides into .in enipl\ spai'o de\oted to the icceptioii 
ol an, but it is not e\ei\\\heie smooth hut is inteiiupted In the occiui cnee 
of ah coll These .tie piodueed In membi.inous ualls i.iised to a little 
lieight Thei aie not all ol this sh.ipe, hut uhen the u.ills aie inoduced out 
in length and Midth .uul eonneeted togethei, the h.ns (sinuses) aiefoinied 
almost into hexagons, .ind bent .it the (oineis ol the sniusfs the memlnaiie 
IS extended a little .is an ininndibnlum is constituted, and thus the lungs 
of the smallei fiogs aie i.ishioned But in those whidi are l.ngei, the nails 
aie laised higliei, and liom the middle ol the enclosed llooi Ihiec come out 
\eii Mbibh ineieasiim Tin* p.ii fit ions in the sm.illei fiogs arc almost 
iiiiobsenable, but those in the biggei ones .tie bound into thice othci 
sinuses .is tlun dnide the ine.itei sinus len niiiidi The .nea, oi the 
floor of the sinuses, admits the sessels spoKen of abine .ind the .utcii 
ilselt sometimes ends ineonspu uoush . loik-liKe in the middle, hut 



Pig I Showing lungs of fiogs witli ti.idiei .Utadiod ( V) Lu\n\, winch is scmi 
eaitilagmous (B) Ihnia, which is iciuiateh closed uid opened it the 'uunial s need 
Air being enclosed, it keeps the lungs expanded (C) Site of the licut (D) Extenni 
pait of the lung (E) Piolonged letc of the cells (P) Piolongation of the pulmonin 
aiteiy (G) Coiicaie pait ol tlic lung dnulod through the middle (H) Prolongation 
of the pulmonaiy vein lunning thiougli the apices 

Pig II Containing the most simple cell without the inteimcdiite walls (magTufied) 
(A) Interioi llooi of the cell (B) Paiictes scpai itcd ind bent (C) Tiunk of 
nionary arteiy w'lth attached bi inches, as if ending in a netwoik (D) Tiunk o 
pulmonary vein wandenng with its blanches oiei the slopes of the walls (E) Vessel in 
the bottom and coiners of the walls with the lamilications of the lete continued 



fulthei on is spiead out at the gieatei passage and sometimes manifestly 
pioduces anothei hianch, but the vein glides down the innei slopes of 
the walls and is mingled with these, and, the blanches having been sent 
down thiough the walls, at length iiins into the aiea 
Obseivatioii by means of the micioscope will leveal moie wondeiful 
things than those viewed in i eg aid to meie striictiue and connection 
foi while the lieait is still beating, the coiitiaiy (i e , in opposite diiec- 
tions 111 the diffeieiit vessels) movement of the blood is obseived in the 
vessels, — though with difficulty, — so that the circulation of the blood is 
clearly exposed This is nioie cleaily lecognized in the mesenteiy and in 
the othei gi eater veins contained in the abdomen 

Thus, by this impulse, the blood is diiveii in veiy small (sti earns) 
through the aiteiies like a flood into the seveial cells, one or other blanch 
cleaily passing thiough oi ending there Thus the blood, much divided, 
puts off its led coloui, and, earned louiid in a winding way, is ponied 
out on all sides till at length it may leach the walls, the angles, and the 
absoibing blanches of the veins The powei of the eye could not be ex- 
tended further in the o]ieiied living animal, hence I had believed that 
this body of the blood bleaks into the empty space, and is collected 
again by a gaping vessel and by the stiuctuie oi the walls The toituous 
and diffused motion of the blood in diveis diiections, and its union at a 
determinate place offeied a handle to this But the diied lung of the fiog 
made my belief dubious This lung had, by chance, pieseived the redness 
of the blood in (what afteiwaids pioved to be) the smallest vessels, wheie 
by means of a moie peifect lens, no moie theie met the eye the points 
foimmg the skin called Sagiino, but vessels mingled annulaiij^ And, so 
gieat is the divaiication of these vessels as they go out, heie fiom a vein, 
there fiom an aiteiy, that oidei is no longei pieseived, but a network ap- 
peals made up of the piolongations of both vessels This netwoik occupies 
not only the whole floor, but extends also to tlie walls, and is attached to 
the outgoing vessel, as I could see with gieatei difficulty but moie abun- 
dantly in the oblong lung of a toitoise, which is similaily membianous 
and lianspaient Heie it was cleai to sense that the blood flows away 
thiough the toituous vessels, that it is not poiiied into spaces but always 
woiks thiough tubules, and is dispeised bv the multiplex winding of the 
vessels Noi is it a new piactiee of Natuie to join togethei the extiemities 
of vessels, since the same holds in the intestines and othei paits, nay, 
wliat seems moie wondeiful, she joins the uppei and the lowci ends of 
yeiiis to one anothei bv Msible anastomosis, as the most learned Fallopius 
has vciy veil obseived 

But 111 01 del that \ou mai moie easilv get hold of uliat I Jiaie said, and 
follow it vith Aom ovn sight, tie vith a Ihiead. just vheic it joins the 
heait, the pioiectnig swollen lung oi an opened fiog while it is bathed 
on cieiv side with abundant blood This when clued will pieseiie the 

[ 95 ] 



\essels iurgid blood You ^\lll soc this aoij uoll if ^ou o\.iinmc it 
bv the mu'ioscopo ol one Ions aframsl Iho lioii/onlal sun Or \(m nun 
institute aiiotlu'i inotbod ol sooni" those thinirs Plaoo the liuif? on a 
ei.^slal })]ate illuminated belon thiouuli a lube bj a lifrhlod candle To 
It bring a micioseope ol t\\o lenses and thus the Nessels distnbutod in a 
nng-like lashion \\ili be disclosed to \ou lU the same aiiangcmont of 
the instiuments and light, mui mil obsene tin* nunement of the blood 
thiongh tlie \ossols in {piestion You mil Aouiself be able to continc it 
bj diflorcnt degi oes ol light nbu h escape dost npt ion b;v the pen About 
the mo^cment of the blood, bo\\e\(i one thing sho\ss itself, ^^{ntln of 
join speculation The auiiele ,iii(l the lienit being ligatniod. .ind thus 
doprned of motion and the impulse which miglit he dcined fiom the 
heait into the eonneete<l %essels, the blood is still mo\ed b\ the ^clns 
low aid the beait so tlial it distends the \essc 1 s b\ its eftoit and copious 
flow This lasts ,se\cial lionis At the end, howevei, espoeiaih if it is 
exposed to the snlni ia\s it is agitated, not b\ the same coutimiccl 
motion, bill, as it imiielled b\ ebanging impulses, it ad\aiues and iccccles 
fluctuating along Die s.mie wa\ This tabes pi. ice when the hcait and 
aiuiele aie lemoicd iiom tlio hod\ 

I'^iom these things, Iheiefore as to the tiist juoblems to lie sohed fioni 
analogx and tlio simidieilx which Xalme uses in all hei opci.itions it can 
be intcriod that that netwoik whuh lonnoih 1 heliexed to he ncnoiis m 
naliiic, mingled in tlie bladdeis and sinuses, is (lealh) a xosscl caiunig 
the bodx of blood tliitlicr oi cam mg it awa\ Also that, although in the 
lungs of pci loci aninmls the xossels seem somolmios to gape and end in the 
midst of tlic netwoik ol iings, luweithelcss, it is hkch that, as m the cells 
of flogs and tortoises, that xesscl is piolongcd tmthci into xei\ small 
vessels in the foiin of a netwoik, and these escape the senses on account 
of their excpnsite smallness 

Also fiom these things can be solxcd with tlie greatest piobabilitx tiic 
question of the iinitnal union and anastomosis ol the \cssols Foi if Natiuc 
turns the blood aboni m \cssels, and combines the ends oi the xosscls in a 
netw'ork, it is likely that in othei cases an anastomosis ,101ns them, tins 
IS eleaily iccogm/ed in the blacldci of fiogs swollen with nrine, in wlncli 
the above desciibed mol ion of the blood is obscixed tluough the tianspaient 
vessels loined togethei bv anastomosis, and not that those xcssels haxe le- 
cevved that connection and com sc whicli the veins 01 fibics inaik out m 
the leaves of nearly all trees 

To wdiat pnipose all these things may be made, bexond those winch I 
dealt wnth in the last letter concerning the pnlmonaix mixing of the blood, 
X’ou youiself seemed to leeogni/e leadilx, noi is the opinion to bo lessened 
by yom vciy famous device, because by yoiii kindness xon haxe entrusted 
me xxatli elaborate letters in which you philosophised subtly by obseixing 
the stiange poi tents of Natnic in x’-cgetables, xvhen we xxonder that apples 

[ 96 ] 



hang from trunks not their own, and that by giafting of plants the 
pioeesses have piodnced bastards in happy association with legitimates 
We see that one and the same tree has assumed diverse fashions m its 
branches,— while here the hanging fruits please the taste by a grateful 
acidity, there they fulfill eveiy desiie by then nectar-like sweetness, and 
you fuimsh credibility to the tiuth at which you wondeied when in Eomc, 
that the vine and the jasmine had come foith fiom the bole of the 
Massilian apple He who cultivated the gaidens with a light inserted 
folk made these clever things with bigger blanches, and he taught the un- 
reluctant trees the bnngmg forth of diveis things About this matter 
Viigil in the Geoigics fitly sang — 

“They ingraft the spiout fiom the alien tiee 
And teach it to grow fiom the moist inner bark ” 

You lav baie the seeiet of this ivonderful lesult by youi philosophising 
method, foi we might considei the acid juice of the Massilian apple 
sweetens to the nature of puie wine as fai as the pai tides of that juice maj^ 
lun thiough the small openings of the tiunk pioper, but not in the same way 
can they come up into the continued tubules of the vine Here, stiried by 
their own motion, and tom away beyond then usual oidei by the impulse 
of those following aftei, and bioken up, they must confoim themselves to 
the supei induced foim of the passage, and put on the new iiatuie by which 
the vine oi jasmine is bi ought foith Natuie puisnes a like mode of opeia- 
tion m the lungs, foi the turbid blood returns fiom the ambit of the body, 
widowed elsewheie of pai tides, to which a new liumoui fiom the subclavian 
vein is added to be peifected by the fuithei action of Nature This hap- 
pens 111 ordei that it may be aiianged and piepaied into the natuie of 
pal tides of flesh, bone, neive, etc, while it enteis the myiiad vessels of 
the lungs It is conducted into diveis veiy small threads Thus a new 
foim, situation, and motion is prepaied foi the pai tides of the blood, fiom 
which flesh, bone, and spiiits may be foimed Tlie tiustwoithiness of youi 
saying is iiici eased by the like stiuctuie of the seminal vessels as if a 
ceitaiii nutiition of the living animal weie also its legeneiation 
I have put these few little observations into a lettei that I might in- 
eiease the things found out about the lungs If I have set in motion all 
the point of my obseivations I have owed the addition to the fiog You 
will bung out the tinth and dignity of these matteis by youi authoiity 
and contiivance Sleantmie, apply youiself happilj- to philosophv, and 
may vou go on to lender me altogetliei happi" bv nici easing a little mj 
leij’ uiiimpoitant thoughts of youi niitnigs “De Animalium Motu ” 
Faiev ell' 


Bologna. 1661 




1664 

NIELS STENSEN 

ON THE MUSCULAR NATURE OF THE HEART 




NIELS STENSBN 


(Courtesy Annals of Medical History ) 


NIELS STENSEN 

(1638 1686) 

CTTl ^IBLS STENSEN or “Nicholas Steno,”i as he was also called, was hom on 
C/ V January 20, 1638, m Copenhagen, Denmark His father, Steen Pedersen ,2 was 
a goldsmith who died before Niels was six years of age When his mother re- 
married, the hoy was sent to live with his grandparents and it may he assumed that 
they provided him with a tutor in order that he might ctualify for training at a 
university 

In 1656 Stensen entered the University of Copenhagen For his preceptor, who 
also was to act in the capacity of adviser, he chose Thomas Bartholin (1616-1680), 
the esteemed professor of anatomy He not only studied anatomy hut also devoted 
much time to the mathematical sciences At the university he learned Hebrew, which 
was to he a great asset to him in later years when he became affiliated with the 
Roman Catholic Church His later published works also show that he was proficient 
in Greek, Latin, French, German, Dutch, Italian, and English 

In 1658 the classes of the University of Copenhagen were interrupted by the 
Swedish invasion of Denmark The Swedes besieged Copenhagen Stensen, in the 
short war, held the commission of corporal in the student regiment, with eighty-six 
scholars imder his charge 

After spending three years at the University of Copenhagen, Stensen went to 
Amsterdam, where he studied anatomy under Professor Gerhard Blasius (1626- 
1682) During his first year at Amsterdam, Stensen discovered the duct that bears 
his name, the secretory duct of the parotid gland, which he found m the head of a 
sheep he had dissected Not long afterward, Stensen communicated his discovery 
to his preceptor, Bartholin, in a letter written from Leyden on April 22, 1661 

The letter provoked a quarrel with Blasius who claimed the discovery as his 
own There is no evidence to support the claim of Blasius, and Jean van Hoome 
(1621-1670) of Leyden named the duct after Stensen Because of this quarrel, 
Stensen left the University of Amsterdam to contmue his studies at the University 
of Leyden, where he worked under Van Hoome and the celebrated Frenchman, 
Frangois de la Boe Sylvius (1614-1672) Not long afterward Sylvius was able to 
demonstrate Stensen ’s duct in man 

Stensen next began to investigate the glands of the eye, and in the latter part 
of 1661 he published an account of the glands of the eye and the vessels of the nose 

From 1662 to 1663 Stensen was busy investigating the muscles In 1664 the 
death of his stepfather called him home to Copenhagen When he returned to his 
native city, he published a most important work “De musculis et glandulis observa- 
tiomim specimen, cum epistolis duabus anatomicis" (Hafniae, Lit M Godiecenus, 
1664) He dedicated this work to Ehng Friednch IH of Denmark, to whom he had 
been recommended by Bartholm 

The observation, recorded in the aforementioned work, that the heart was com- 
posed chiefly of muscle fibers was one of the great anatomic discoveries of his 
era, and we consider it a special privilege to be able to present Stensen 's description 
of the heart m translation 

’Other nriitions of Sten'^cn Stenon Sti^none Stcnonis S’cnonius 

^Lutz spelled this name ‘ Peterson Miller, “Pedersen ’ 

[ 101 ] 



Tlio importance of this discovery, according to Miller, waB noted in 1665 hy a con 
temporary, do Hcdovvjlc, who said of It, "This ohseraation oaerthrew a system to 
which medicine clung most tenaciously,” and Albrecht a’on Haller (1708 1777), 
the great physiologist, in 1771, referred to this aaork as a golden hook which con 
tained the rich seed foi new discoa erics 

Lutz referred to Kurt Sprcngcl (17GG 1838) as recording that Gioaanni Borclli 
(1608 1G79) claimed in 1G80 that he had obscracd the stnicturc of the heart in 1657, 
while ho wsas working with Malpighi The only other person to consider the heart 
a muscle before Stensen aaas an tinknoaan Alexandrian who avrotc a book on the heart 
which is placed among the Hippocratic works Tollowlng Stensen, Elchard Lower 
(1631-1G91), in 1G69, also demonstrated the muscular nature of the heart 

In 1665, Stensen aacnt to Paris, where ho continued his anatomical work and also 
porfonned dissections at the £colo do Mddccinc During this year, Stensen gave a 
lecture on the anatomy of the brain According to some authorities, modem 
neurologic observations received their impetus from Stensen 's observations which 
are found in his lecture on the brain 

Stensen traveled to Southern Franco in the latter part of 1665 and spent the fol 
lowing spring in Italy In Italy, he was kindly received and Grand Duke Ferdinand 
ni, who, as we hav e noticed in our account of hlalplghl, had done many things for 
the cause of science, appointed Stensen one of his physicians and gave him a pension 
and a residence Stensen then followed the court which moved to the surroundmg 
Italian cities In 1667, at Florence, he published an extensive work on the muscles, 
"Elementonun Myologlao specimen sen musculorum descrlptlo geometnea ” 

On November 2, 1667, Stensen, w’ho had given the matter considerable thought, 
was converted from Lutheranism to Roman Catholicism In December of that year 
the Danish King, Friedrich III, oiTcred him a professorship at the University of 
Copenhagen Stensen wrote to the King asking him if ho was willing to accept his 
new religious preference He received no reply and on February 2, 1670, the King, 
who had been very ill, died In 1672 the new King, Chnstlan V, commanded Stensen 
to return to Denmark to assimie his professorship, which he did His position as a 
Roman Catholic professor in a Lutheran university was precarious For some reason, 
probably his growing attachment to the Roman Catholic Church, he resigned his pro 
fessorship in 1674 He then returned to Italy' and devoted himself exclusively 
to the work of the church 

In addition to his anatomic discov'cries, Stensen made many interesting geologic 
observations He compared fossil teeth found in the Tuscany deposits with the teeth 
of the living shark He compared deposits of rocks wherein fossils could be found 
with deposits wherein no fossils could be found, and came to the conclusion that the 
earth was at one time completely submerged in water Stensen also laid the founda 
tion for stnictural geology, believing from his studies that the movements of the 
earth were the cause of origin of vertical strata of rock which once had been hori 
zontal 

When Stensen returned to Italy ho assumed charge of the education of the son 
of Grand Duke Cosimo III 

In 1676, Stensen was ordained a priest, and, in 1677, he was consecrated Bishop of 
Txtiopolis Jean Frederick, Prmce of Bninswick, called him to his court shortly 
thereafter. Pope Iimocent XI allowed him to leave Italy appomtmg him ' ‘Apostolic 
Vicar for the Northern Missions ’ ’ Stensen spent the remainder of his life partly 
at the court of Jean Frederick and partly in visiting Roman Catholic missions in Ger- 
many He died at Schwerin on November 25, 1686, and is buried m the Basilica 
of Saint Lawrence in Florence, Italy 

^See pvge 167, biogriphic sketch of Albiccht \on H illoi 

[ 102 ] 



Nicolai .Srsf^ON-t$ 
D E 


MUSCULIS 

E T 

GLANDULIS 

Obfcrvati.onum Specimen. 

Cum 

Epifiolis dmbns AnAtomkis 



^MSJELODA-Hr, 

Ajmd P E T R V M k G K A Ka> ^ i or* ^ 



ON THE MUSCULAR NATURE OF THE HEART t 

I P ONE dosiics to a})ph llio woid imisdc to (he Iic.til, one must fust 
dcmonstialc the pioposition dial iht h<ai( n (inhi a musdc Tins is 
deduced iiom nioie deladcd lads uludi ] shall shoith piesent 
In all the substance oi the hem I Iheie ofcuis nothin" except (ntaia, 
vcin'i, naves, fihas and manbiams And m the imisclc, exicpt the abo\e 
mentioned, theie ocem no otluns 1 omit lat .ind hone, bcH.iusc all hearts 
do not have this, and no nuisde h.is it ^\hoe\tl ot the anatomists should 
demonstiatc fibeis distindh in the ii.iieiidiMiia should attiibutc it not 
to the senses but to genius ] saw in ecilaiii splendid ]iKi)aia(ions lineai 
stiuetiues runiiiiig on the suitace ol the he.ut, whuh howevci wcic not 
Ij mphatics, but dissection showed them to be tiuh nencs A neiious 
plexus was demonstiated b\ Knllopnis at .lutopsc, who belic\cd that thc\ 
wcie dispcised not onh o\ei the sui i.iee but that the\ penctiatcd into the 
intenoi 

Among none of the fibeis of the head docs one meet, in examination 
fibeis of which the centei is not ficsln, and both extiomcs tendinous, this 
moieoiei is common to all the fibeis ol the niiisdc 
And thus e\ci\ thing is in agieement, and tilth imiselc nun be at- 
tiibuted to the heait, noi can it be olheiwiso, fiidi/ the heat mads the 
name of mnscic, because d has tendons and Jlcsh and ncncs 

This the great Ilippociales appeals to direct h op])osc neieilheless 
Ills words when compaied with oiiis would seem to be in intimate agiee 
ment, he said tiuh that the stiength oL a iiuisele was not in the tendon but 
m the flesh AVliatevci icallv was the opinion oi this autlioi, Ins woids aic 
only slightly diffeicnt fiom oiiis 

If it be tiue, and the truth ol an obscnatioii is dependent upon its coi- 
leetness, tint in the head nothing is lacking which would make it a imisele, 
and not denying that muscle has been demonstiated ni the licait, the head 
thus IS not a substance sia gcneiis, and so cannot gcneiate eeitain sub 
stances as heat (file), innate waimtli, the seat of the soul, noi can it pio 
duee eeitain liumois as blood, ccitaiii spiiits oi ntality But lioweiei 
tliat may be, I am examining solely the substance, thus, fioni the 
fibeis pioceeds all movement of the heart, occuiiing as a plieiionicnon of its 
own , wdiieli subject, liowmier, I wash to laigclj’’ omit at piesent and 
defei a consideiation of it until a latei time 

♦Stensen, Niels De muscuhs ct gJaiiduUs ohsci vatwmtm specimen 
duahns anatomxcis, Amstelodanum, OP Le Giand, 1601 90 pp Tianslatecl m Maurice 
Walsh, MD, Ma>o Clinic 

tOnly such a portion of Stensen's book as deals with the mnsculatui c of the heait has 
been translated — Translator 


[ 104 ] 



1705 




AORTte 


^NSURfp 


ClHivcy 




WILLIAM COWPER 


(Courtesy Charles C Thomas ) 


WILLIAM COWPER 

(1666 1709) 

^ -viLLIAM COWPER, sometimes written as Cooper, was bom in Petersfield, 
KSV Sussex, England, in 1666 He was the youngest son of Richard Cowper 
Young Cowper at the age of sixteen was apprenticed to William Bignall, an English 
surgeon who resided in London At a later date, it is known, he continued his ap- 
prenticeship under John Fletcher 

In March, 1691, Cowper became free of the Company of Barber Surgeons of 
London He settled in London, devoted himself to the study of anatomy, and three 
years later he published a work entitled “Myotomia Reformata, or a New Admin- 
istration of the Muscles of the Human Bodies, wherein the true uses of the muscles 
are explained, the errors of former anatomists concerning them confuted and several 
muscles not hitherto taken notice of described to which are subjoined a graphical 
description of the bones and other anatomical observations” [London, 1694] 

This was a cleverly executed work and no doubt was one of the reasons that led 
to Cowper’s election to a fellowship of the Royal Society in 1696 

In 1698 Cowper published a beautiful atlas with an original English text and 
the following long explanatory title page “The Anatomy of the Human Bodies, 
with figures drawn after the life by some of the best masters in Europe, and curiously 
engraven in one hundred and fourteen copper plates, illustrated with large explica- 
tions, containing many new anatomical discoveries and chirurgical observations To 
which IS added an mtroduction explaining the animal oeconomy with a copious index 
by William Cowper Oxford Printed at the Theater, for Sam-Smith and Benj 
Walford, printers to the Royal Society, at the Pnncess Arms in St Paul’s Church 
Yard, London, MDCXCVIII ’ ’ 

The publication of this work brought a storm of protests from Godfrey Bidloo, 
the famous Dutch anatomist Bidloo in no uncertain terms asserted that this work 
was a plagiarism of his "Anatomia corporis humani, centum et quinque tabulis 
ad vivum delineatis ’ ’ Bidloo had origmally published this work at Amsterdam in 
1685 In 1700, with much bitterness, he called the attention of the medical profes- 
sion to Cowper's illegal use of his work in a fifty-four-page pamphlet, ‘‘Gulielmus 
Cowper criminus literani citatus corum tribunali ’ ’ 

In the following year, Cowper replied with his satirical pamphlet, ‘ ‘Euchanstia,” 
in which he stated that the figures for the atlas originally had been drawn for 
Swammerdam, that the English publishers had purchased the impressions and that 
he had written entirely new descriptions for the English edition 

The truth of the matter was that either Cowper or the publisher had pirated the 
105 plates from Bidloo ’s anatomy Cowper had supplied nme additional plates 
He had increased the usefulness of Bidloo ’s plates by adding several references to 
them The original drawings had been made by the famous Belgian artist, Gerard 
de Lairesse (1641-1711) A controversy exists concerning the identity of the en- 
graver of the copper plates, but usually he is considered to have been Lairesse 
Cowper, however, had supplied an original English text, and in an obscure place in 
a long preface he had said that the engravings “were sometime since Published bj 
Dr Bidloo, now Professor of Anatomy in the University of Leyden ’ ' 

[ 307 ] 



In splto of the quarrel, Cowpor maintained his prestige He -was the outstanding 
British anatomist of his ora and among other things hccamo the teacher of the 
famous surgeon and anatomist, William Cheselden (1688 1762) In 1702 Cowper 
puhllshed his desciiptlon of the tuo glands whote ducts. In man, open Into the mem 
hranous urethra Although these glands are now known as “Cowper's glands,” 
they were originally described by Jean Mdrj (1GJ5 1722) In 1681 

Cowper contributed several Interesting papers to the “Philosophical Transactions” 
of the Eoyal Society In 1687 he confirmed Malpighi's demonstration (IGGl) of the 
capillary function of the pulmonary arteries and veins by demonstrating the capillary 
circulation in the dog and cat CowTper was the first (1705) to describe aortic in 
sufiicicncy and he paid particular attention, In his description of it, to the slow 
pulse that accompanies the condition This most Interesting account wo arc ropro 
ducing herein As we shall later note, Vlcusscns in 1715 also described it and 
Corrigan in 1832 published his classic account of the condition 

Cowper sulTcred from asthma and dropsy In the last j cars of his life, "o that he 
finally retired from the strain and strife of London to Bishop Sutton in Hampshire 
to conserve his health and strength Yet his success was only fleeting, for ho died 
a comparatively young man at forty three, on the eighth of March, 1709 A stone, 
placed in the wall of the little church at Bishop Sutton by his widow, remains to 
guard his memory 


[ 108 ] 



OF OSSIFICATION OR PETRIFACTIONS IN THE GOAFS 
OF ARTERIES, PARTICULARLY IN THE VALVES 
OF THE GREAT ARTERY* 


By 


WILLIAM COWPER 


Surgeon, and F R S 


H OW FAR anatomical inqunies infoiin ns lespecting the tine seats and 
causes of diseases, which have been asciibed to the want of spiiits 
m some, and of ladical moistme in aged people, etc, may be in some 
measuie seen by two obseivations, among otheis, published m the Tians 
No 280 the fiist theie mentioned is of a young gentlewoman, in whom 
the paiietes, oi memliranes, that compose the trunl^s of the aiteiies of the 
aim iieai the axilla, being veiy much thickened, so that the diametei of its 
boie was lessened to moie than a thud pait of its natuial size, insomuch 
that a pait of the tiunk of the aiteiy cut tiansveisely, veiy much le- 
sembled a Int of the stem of a tobacco-pipe, its sides weie so thick, and its 
boie consequently so much lessened the othei was of the ti links of the 
aiteiies of the leg, that weie obstiucted by peti if actions oi ossifications, 
111 a pel son about the age of 67 Since which, I have met with seieial of 
the like instances in aged people, paiticulaily in the legs of an old gentle- 
man, whose toes and foot weie sphacelated, in which the ossifications di- 
minishing then channels in some places, and totally obstiiicting them 
in otheis, is made leiy eiident 

The dissections of moibid bodies not only instinct us in the seats and 
causes of diseases, but veiy often iiifoim us in the tine use of paits, as 
will apiieai by the following instances The ossification oi peti if action 
in the gieat aiteiy, at its use fiom the heait, has been so commonly found, 
that some think it is constant, how it may be in some animals I cannot lie 
ceitain, but in human bodies I am veil assiiied that whenc^e^ it happens, 
it IS a disease, and in some measiue incommodes those pails in the due ex- 
ecution of then office, as the following cases Mill evince but that this 
papei may be of some use, I shall set doun the symptoms befoie death, 
Minch ma^ help oiii conjeetiiies Mhen the like ofteis again A thin man 
about 30, Mho languished Mith an ulcei in the thigh, attended Mith a canes, 
01 lottenness of that bone, at its aiticiilation Mith the tibia and patella, 
called the knee Mheie all those bones MOie afiected at length fell into a 


'qy‘ ’’ l-ondon 1 21o-21s 1703-1712 ('ibrklpf'd 

[ 300 ] 



lino ])hlhisis, ,111(1 ( mifilii'd iij> no siii.ill (iii.iiilif\ ol jiiis, some nionllis ]jc 
foio his (l('.ill) T lic(ju(‘iilh s.iu iiiin ^\ll(•ll Ik* would ollcn ofioi me Ins 
wnsl, to Joel Ills uiusiujil inilsc, wlndi w.is wont to .iiniiso liini, llie.iilen 
Ihoie inis.siii'f soiik'I lines oiu*. sometimes two slioKes in si\ oi sc\en, ,i( 
hi si ho told me he ohsened it missed Init one in ten. Imt ,it h'lmlli tliosc 
stojis hce.imo nioie Jie(iuent. esp(‘( mils on .in\ ,i':i(,ition of the hods oi 




mind, though a polypus in am oi the gicat icssels about the heait mav JH 
duce that simjilom, -^et its continu.ince so long beloic death, shows it 
owuiig to some othei cause, as appealed on o]ienuig the heait .ind giwt 
aiteiy oi this iieison 

Fig 11 leiiieseiits llie tiuiik oJ the gieat alien o]iened and displaced, 
aaa, the thiee seniiluiiai valves ol the aoita, w'liieh liindei the blood liom 

[ 110 ] 




letiuiiing 1() Ihc Iumi 1 .lilci il is oNpclIcd llicius 1)\ ils s\slolo oi conliac- 
lion, llicse ^<ll^os in lliis c.isi' ^\^‘l(' snnu'wli.il lluclvci, .iiul not so pliable as 
naUnalh, and did not so adoini.ilch .ijiph to ( a( Ii otliei , as is oxpicsscd 
In aan, bbg 14 Whence it liaj)])ened soinetiim's that llu blood in the gieat 
.iilciv (A, hhg 11) would K'eoil, and inteiinpt tin lieait in its s\ stole 
But tins stubhoi niicss ol these \al\<s w.is owiiiir to ,i hoin oi stoiu sub 
stance, 111.11 ked in the s.inl fmnie which apjx.iicd nincli jil.iinei when the 
^al^es weic di\, <is lepiescnited in the fiirnie heiie.ith, iii.iiked with an 
(Id, the two \.d\('s jnnned out and diiocl h, the' jieti il.ic tion oi sloin both 
.il then pinetion In this inst.nice I ohsensed the hit \(‘nlii(*le of the 
heait, exjnessed .it (!(!, 1)1), n. fi, to he .i little dil.iled lioin its iialiu.al 
si/e, but w.is not, h\ two ji.iits in thiee so I.iil'c .is the left \cntiicle of 
the heait ol a siibieci J h.ne dnsected Tlie s\ nijilonis, some sc.iis hefoie 
the death oi this ])eison, who was .ihont 10 se.iis ol .itre wcic oxtiaoi- 
dinai.s shoitncss ol bie.ith csjicci.ilh on .in\ l.ilmne with .in intei mission 
of one stioke m thiee ol the pulse, the jmstuie ol sit tun: up was inoie 
eligible than am otlie. he eomplained ot uie.it t.iintne'.>> and now .and 
then pain .ihout the he.iil, the extiemc jmits oltm cold, which tow.aids 
his death ineieised iiioic .ind nioie on him, his bus .ind .iinis hciiiu nioiti- 
fied some houis heloie (Jn opeiunu the chest, the hc.ut, ]iai tieul.iih its 
leil xcntiiele, w.is lound l.ugei th.in th.it ol .in oidin.m o\, .uid filled 
with coagulated blood, the s.ihes ot the gie.it .ut(i\ com, Fiu 31, wcie 
lictiified, insomuch tli.it then could not .ippio.ich e.icli othei, .is evpiessed 
in Figs 12 and 34, but .in oiitice, leinc'sented .it Fiu 3"), lemaiiiccl alwa^s 
open bs the pctiilaclions hh. Fig I'l, .md cm. h’lu la, which had clogged 
these xahes, .ind lundeiod then .iiiiilic.ition to each othci, as in a natuial 
slate IS lepicsciitcd in h’lgs 32 .ind 14, c/cm 
The explication of the s'siiiptoms in both these eases is oh\ious enough 
foi though the peison in the hist instance did not die of the same dise.nsc 
as the othei, jet the sjnijifoms in his illness pl.inih showed what iiuist 
follow fiom the disoideis oi these \.d\es, .is thew .ne lendcicd iiioic oi less 
useless, foi as then office is to pie\cnt the letuiii of the blood into the 
heait, in its diastole, bj exaeth shutting u]) the passage of the aoila, like 
the valves in watei engines, so li In am accident thci aie hindeiecl fioni 
doing then diitj, as thej a\cic In the petiifaetions montioned, the conse- 
quences must be, not only a legingitation oi blood into the heait, but tlics 
bauUc its impulsive foice, when the musculai fibics in these lahes can- 
not contiact, to piepaie the passage foi the blood of the left xentiicle, when 
it IS to be expelled into the aoita Hence the iiitei missions of the pulse in 
the fiist instance may be accounted foi In the lattei instance, tliese valves 
weie wholly useless, and the ciiculation became iiioie difficult, as appealed 
by the refiigeiation of the extieme paits, the moitifications, etc In both 
these cases, the left ventiiele of the heait wms dilated piopoitioiiablv to 
the bad constitution of these xmlves, wdiich plainly show's these valves 

[ 112 ] 



give such assistance to the heait, as it cannot be Avithont, and that it giadu- 
all}^ siifPeis accoiding to tlieii indisposition 

Bet 01 e these papeis weie sent to the pi ess, I had an oppoitnnity of ob- 
seiving a like instance of that fiist mentioned, in an elderly gentleiiian, 
about 72, who sometimes had intermissions in his pulse seieial yeais be- 
foie his death, in whom I found diveis peti if actions in the initial and 
semiluiiai valves of the left ventiiele of the heait 
The Explanation of the Ficjuies — Pig 11 lepieseiits the left ventiicle 
of the heait opened, etc , AAA, the inside of the aoita slit open to the left 
ventiicle, BB, the bulbous tiunk of the vena puliuonalis divided tlnough, 
and pinned aside, to show aaa the thiee semilunar valves of the aoita, 
which hindei the blood fioiu letuinmg to the heait, h, a small stony sub- 
stance at the conjunction of two of the semilunar valves, expressed at the 
below this figure aa, parts of the two valves dried, h, the petrifaction, 
as it appears in the dried valves, C, pait of the lower trunk of the vena 
cava, cut off immediatelv above the liver , ccc, the left auricle opened 
and pinned out, DD, the sides of the left ventricle divided and diauii 
aside, to show its inside dd, ee, GG, dd, the mitral valves of the left 
ventricle of the heart, or aiteiia pulmonica, divided and turned aside, 
ee, the caiiieae columnae, whence spring the tendons fastened to the valves, 
dd, expressed by df ir Fig 13, a transverse cord or tendon, by nhich 
the columnae eaineae are diawn neaiei each othei in the systole, or eon- 
tiaetion of the heait, when the blood is expelled into the aorta, bj’’ which 
the tendons expressed ff. Figs 13 and 15, dian the mitial lalve laterally, 
by which means its oiifice, gc in the said figure, is not only closed to pre- 
vent the return of the blood by the vena puhironalis, but at the same time 
it opens a passage for the blood of the aiteiia magna, by witlidiauung the 
mitral valve d, Fig 12, from the orifice of the aorta, aaag, GG, the internal 
surface of the left ventricle, vheie it is someuliat smoother as it leads to 
the aorta, gg the trunk of the coionaiv vein divided uhen filled with 
r\ax, hh, the coronary aiteiv nr like manner duided, i, one of the trunks 
of the rena piilmonalis. III, the three orifices of the ti links of the rena 
pulmonalis, as they open into the bulbous tiunk, expressed at BB, II, llie 
cone of the heart 

In Fig 12, A IS irart of Ihe aorta next the lieait, aaa, the three semi- 
lunar vahes, as thev appear next the heart ni a natural state, nheii the 
heart is m diastole, and the blood hindered br these rahes from letuin- 
iiig to Its left rentiicle hh, part of the basis of the heart cut oft, cc, the 
tuo columnae eaineae of the left rentiiele, d, the initial rahe, fi, the ten- 
dons springing from the eaineae columnae and nisei led into the upper 
and middle parts of the rahe as veil as to its loner margin, nhieh is 
bettei expressed in the folloning fiyme g the orifice of the aoita com- 
pletolv closed In the application ol these three \al\es to each othei 

rn-] 



18 shows llu> s.inic ]>,'ii(s jis mi IIic ])i (•( cdmi; fifruif, .is lhe\ .np 
jicMU'd wlion the \,ih('s ol I ho noil.i woio jii'lnhod, oxcoplm”: a, winch 
icpicscnts .1 ji.iit ol ono ol llio \.ih<‘s fhal w.is not (o\oiod witli Iho pctii- 
l.U'lion, hhh, llio poll il.iolioiis on fho losi ol tho \.iI\os, f ,i siii.dl pcliif.ie- 
tion on Iho inili.il \.d\(', lihh, soim* ol Iho ti.insvdso lindons, which diaw 
the c.unoiio column. u' to each othoi, when tho ho.iil is in SAsfolc, foi the 
moie oftcctn.il closni"' Iho oidno ol fho initi.d \.iho, o\[)iesscd heic .it q 
Figs 34 ,ind F) show tho s.imo jiaits lopioscnlod in tho two picccding 
hguies, .is tho\ .iiijio.ii Mowed towaids tho hoail, when diicd and dis- 
jd.'ned, AA tho tnink ol Iho aoita, mut h'lg 11. tho somiliin.ii %.il\es in 
.1 n.ilin.il st.ilo, when tho blood in fho .iiloiios pusses them close to c.icli 
othci , hhhh, the liiiiiKs ol fho two (oton.m .iiIoiks ciif oft , an, Fur I"), the 
semilun.u \.il\es iietiified, ( Iho oiifne of tho mifi.il \.iho next tho Acn.n 
pnhnon.ilis, c/c/d tho inteinal suit.ico of the miti.il \.ihe le.iding info the 
left ^cntlIole, ccc, the colnmnao c.iino.io, f}. then tmdons, qq, the turns 
\eise tendons, which duiw the flesln colnmiis to each othoi, wlion thehc.nit 
IS in ss stole 


[1141 



1708 

ANTONY VAN LEEUWENHOEK 

HIS CONCEPTION OF “THAT MOTION WHICH 
WE CALL THE PULSE” 



Antoistius a Leeuweisthoeil 


Qy\.c^<a Cl/ac( €10.14^ o(ojic/t^enj-is- 


tfe 


/ r 

rncm I / v/y// 






ANTONY VAN LEEUWENHOEK 


(Courtesy Charles C Thomas ) 


ANTONY VAN LEEUWENHOEK 

( 1632 - 1723 ) 

“The Delpinr Oiacle” 

— Molineu\ on Leeuwenhoek 

C/T'NTONY VAN LEEUWENHOEK did not have the advantages of a uni- 
QyV versity training, hut early m life devoted himself diligently to the task of 
perfectmg the single lens microscope He succeeded in makmg this instrument reflect 
a clearer and more accurate picture than did the compound microscope of his era 

With his newly perfected instrument, he studied most assiduously during the long 
period of his life, making many noteworthy observations Leeuwenhoek has been 
accused of making several errors in his discoveries, and it is true that he deceived 
himself in many of his observations However, considering that he was, in many 
ways, a pioneer in the vast uncharted field in which he worked, and taking 
mtQ account the inferiority of his equipment as judged by the excellence of today’s 
microscope, there yet remains a remarkable general truth in many of his observa- 
tions 

Leeuwenhoek was born in Delft, Holland, on October 24, 1632 He came of good 
Dutch stock Some of his relatives were burghers who manufactured baskets and 
operated local breweries His father died early and young Antony was sent to school 
to study for a government appointment He left school at the age of sixteen, how- 
ever, to become an assistant in a dry goods store in Amsterdam There he remained 
SIX years, advancing to the position of cashier and bookkeeper At the age of 
twenty-two he married a young woman named Barbe de Mey and settled in his 
native town Delft Five children were born of this marriage, only one of them 
survived Leeuwenhoek His wife died and he remarried, but no children were born 
from this second marriage Not much is known concerning Leeuwenhoek for the 
next twenty years except that he was appointed to the post of chamberlain of the 
sheriffs of the town of Delft which seemed to be a glorified name for janitor of the 
City Hall We can assume that much of this time was spent in polishmg and in 
otherwise perfectmg lenses for his many microscopes, of which the frames also were 
made by his own hands 

At a later date, Eegnier de Graaf, who had immortalized his name by his dis- 
covery of the graafian follicle of the ovary, and who was also a native of Delft, be- 
came acquamted with Leeuwenhoek and his microscopic discoveries De Graaf, a 
corresponding member of the Boyal Society of London, realizing the importance of 
Leeuwenhoek’s observations, communicated with the members of the society and 
suggested that they ask Leeuwenhoek to write them concerning his observations 
Shortly afterward (1673), Leeuwenhoek sent them his first contribution It was 
written in Dutch, for he knew no other language His first paper was entitled 
“Some Observations made by a Microscope contrived by hir Leeuwenhoek in Hol- 
land, lately communicated by Dr Regnerus de Graaf ’ ’ In that paper he wrote 

[117] 



nljout his microscopic studies of mould of the skin, the flesh, the sting of a bee, the 
anatomy of the boo, and also the anatomy of the louse During the next fifty years 
ho sent the society about 200 letters regarding his observations, and many of these 
subsofiuently were published in the • ‘Philosophical Tr.ansactions ” We have chosen 
to reproduce Loouwonhock's paper, “On the Circulation of the Blood in Pishes,” 
■which he published in the Transactions in 1708 In this paper is found his tpiaint 
conception of the pulse, a conception which of course was inaccurate, for he bcllevdd 
that the -veins had pulsations and the arteries none 

In 1674 Leeuwonhook first observed living protoroa In the followdng years he 
described many species which he had demonstrated in well water, in canal w.ater, 
in infusions of pepper, ginger, and nutmeg, and elsewhere In 1G76 he discovered 
bacteria of various kinds In 1680 he discovered anaerobic bacteria in infusions of 
pepper, and in a letter describing them he recorded the first microscopic observa 
tions ever made on the yeasts in beer That same year he was elected a member of 
the Eoyal Society In 1681, this untiring worker discovered the bacteria of the 
human mouth and intestines, Incltidlng the spirochetes 


Turn confhrccv plin-ovalibuspaftr 
icriam iimpidam , fictic antea dc fr 
ur ftc dicim , ilmiltrcr colorc carcL 
rc£t i oculos fcricbanc binis vero jij 
lorapparcbar paultilum ad rubcdinl 
biinViCcni imppfitis, magiscminc! 



The erythrocytes as Leeuwenhoek saw them in 1696, 
from his Arcana Naturae 


(Courtesy Clba Symposia ) 


Leeuwenhoek confirmed Malpighi’s discovery of the capillary system He recog- 
nized, further, the part the heart played in the circulation Plimmer wrote that 
Leeuwenhoek said, “I never looked upon the Heart as the maker of the Blood, but 
only as an Engine that caused the Blood to circulate, driving it forcibly in to the 
Artenes, and by its opening, giving way for the Blood to come in again out of the 
Veins ’ ’ 

Malpighi, as we have mentioned, was the first to demonstrate the blood corpus- 
cles, but he mistook them for fat cells Leeuwenhoek was the first to give corpuscles 
an accurate description He also was the first to mention the leucocytes 

Leeuwenhoek also did some remarkable work on spermatozoa, his studies causing 
him to become a strong opponent of the theory of spontaneous generation 

Among his many investigations he produced the first true account of the struc- 
ture of the optic nerve He also was the first to describe the fibrillated structure of 
muscle 


[US] 



Interestingly enough, he was the first to use the microscope in a medicolegal in- 
quiry Some material was sent to him which was said to he hair voided from the 
bladder of a woman He found that it was wool from a stocking 

In 1697 Leeuwenhoek was elected a corresponding member of the Academic des 
Sciences of Prance, and he made twenty-six communications to that society 

Leeuwenhoek was visited in Delft by many royal personages including, in all 
probability, Charles II of England, who founded the Eoyal Society, Frederick I of 
Prussia, Queen Mary of Orange, to whom he gave two of his microscopes, and Petei 
the Great of Russia 

Leeuwenhoek lived tb^the fine old age of ninety-one He died on August 26, 1723, 
and was buried m the Oude Kerk in Delft At his decease he bequeathed a collec- 
tion of twenty-six of his microscopes to the Eoyal Society 


[119 3 



ON THE CIRCULATION OF THE BLOOD 
IN FISHES, ETC 

By 

MR LEUWENHOECK.i FRS 

I VIEWED the lie, ills oi se\ei.il fislii s, ji.ii 1 n iihii h 111 , it of llio haigc 
sihci eel, the motion ol \\lu<li histeil ne.u | Iioius, .lilri it w.is tiikcn 
out ot the 1)0(1\ oi the hsii whiiii motion w.is \('i\ leiiulm foi uhen tlic 
blood IS ])iotuidod out ol the heait it is not (,uiied into the uieal ai tones 
uitli the same Aeloiiti uhuh in that <.ise would he o\ < i ( hai ired with the 
Sicat quantlt^ ol blood but the blood thus eoininir liom the liCiiit, is 
loiccd into a sni.ill white Mssel, .ilmost ol llu* sh,ipe ol ,i jieai .ind which 
one would take ioi .i kind ol bkiddei one oi liiee ot wliieh w.is united to the 
gie.nt aiten, .ind the othei to tin lusiit in the lattei oidne is a ^ahe, 
the use of whieh is to iti(\(iil the blood, piotmdiinr lioin the hcait 
into the said sosscl, liom luniiimr b.iek .uiaiii into it which ^cssol liaMUg 
been cut acioss, 1 obsoned the inside ol it to be luinished with a in eat 
many small ii.iitules, so th.it it w,is in .1 m.iiim'i tilled with them, and 
the design ol these inlein.il ])<iiti(les I (omene to be lh.it when the blood 
IS piotiudcd into the \essel, b\ dilating and eoutiaiting UselC, it ma^ 
piesentlv foiec the same into the irie.it .11 ten So that the blood is al- 
most alwa^s lunning with an o.is\ ainl const ant (ouxso though at c\cl^ 
piotiusion it must be in some mannei (lunkcned let that is so niscnsibb, 
that it cannot be obscised oi Iclt And the ease is piob.xbh the same in 
beasts and othei laigc anim.ils 

I have foimeih communicated some dlsco^ellos 1 elating to the cu dila- 
tion of the blood in cels, 11/ , that the blood, coming out of a gicat many 
small vessels ni the tail ol an eel, is united in one gicatci blood-A cssel, 
wdiere the fish-bones begin, and anIicic the blood inns tluough a Aalve. 
foi I obseiAmd that the blood-Amin A\as not onh moAcd in that pait Avheie 
the AmWe is, but also the paits about it, of the bicadth of 4 01 5 bans 
breadth, fiom Avhence it appealed, that at e\eiA piotiusion of blood into 
the heait thiongh the Amhc, the blood stood still foi an instant of time, 
and then falling thiongh the AalA'c, it lan A\uth great SAviftness, and Aias 
thickest just at its piotiusion out of the auIac, but laii thinner 01 slcndeiei 
like the figiiie of a peai , and the A'cin that lecencd this pi oil tided blood, 

‘Trans No 3m p 210 Phil Ti Ro-i Soc LonOon A IGl-lCl, 1703-1712 (abridgrecl 
1809) 

tSpelling of name same as m the original article Note variations from accepted 
usage — P A AV , 1940 

[ 120 ] 



was not eiitiiely filled with it, hnt seemed foi a small space to be as it "weie 
empty, and its parts conti acted, and fmtlier observing it, I saw the blood 
lun slowly and leisuiely along the same vessel 
Piom this observation I imagined, that the same thing happens in the 
heait of a Immaii cieatnre, viz, that there is a gentle and slow protrusion 
of the blood out of the heait into that vessel, called the artery, and conse- 
quently that theie is no such motion there, as is called a pulse, and which 
IS felt 111 the extieme parts of the body, but that the pulses aie only caused 
by the protrusion of the blood thiough the valves in the veins , for I nevei 
observed any violent oi swift protrusion of the blood into the arteries, as 
often as I have viewed its ciieulation and though the blood, by the con- 
ti action of the heart, be suddenly and hastily protruded out of it, yet it 
IS slowly canned into the aiteiy, whereas, on the contrary, it luns into 
the heart from the veins with a violent and swift couise, from whence 
it happens, I suppose, that the lemammg part of the blood in the veins, 
being unable to follow with so swift a motion, is, as it were, violently and 
per saltum drawn or forced thiough the valves, and that it is this sort of 
motion which we take for pulses in the arteries 

To satisfy myself, m the above observations, I have often viewed that 
sort of motion in my arm, called the pulse, at the time when my body was 
without motion and warm, and I judged that the motion, ivhich we per- 
ceived 111 the blood vessel, was not deiived fiom the heart to the hand, but 
conti aiiwise fiom the hand to the arm, and so to the heart fioni •whence I 
concluded, that, like as in the tail of an eel, there are no valves in the 
blood vessels, as far as I could perceive, and that a great many small blood 
vessels, are, as it were, united in that pait where the fish bones begin, and 
make one large blood vessel, where the first valve is, nr the same manner 
111 human bodies, a great many single blood vessels lunning out of the 
hand, are 3oined in the arm, wdiere likeivise the first valve is, thiough winch 
the blood at each piotiusion falls into the heart, producing what we call 
the pulse 

I have several times observed in the exceedingly small veins or capillary 
vessels, a little rising or swelling occasioned by a stronger motion of the 
blood, which I now firmly conclude, to proceed only from the sudden mo- 
tion 01 lunning of the blood thiough the valves I have also observed, that 
in sudden fiiglits, and otherwise, one feels such motions at the end of one’s 
fingers, just as if there were valves likewise in them, thiough which tlie 
iilood gushes, but these sort of motions, I suppose, do only depend on 
that quick motion made by the blood, vhen it inns thiough the lahe in 
the arm by the hand, to uhich ive give the name of a pulse 
In the month of September, having opened an eel, the diameter or thick- 
ness of uhieh uas about an inch and a half, and haling laid open the heart, 
I could not discoiei that part which leeenes the blood out of the great 
rein m order to bung it into the heait But that I miglit the bettei dis- 

[ 121 ] 



covei tliat ])<nt, I ])U']').ik '(1 ,i littlo frl.iss Inbo, niul i)ut il into tlie "le.il 
\cin at a little dislaiieo lioni the lieait, and tlicn l)le\s some an into the 
said ^eln, as iinicli as mifrlit take nj) the sjiaee of .ibout li.ill a pea tins 
ail passed lliion^li tlio f,ne.it mmii into ,i little bladdei that laj on 
the side ol the be.iit, and no soonei A\as the .111 ^mt into that bl.iddci, but 
it fiist eontiaetcd, and then dilated itsell, so leirnlaih. and in surh a nian- 
noi that nhen the hcaif eonti.uted itsel), jnsf as il it neie fronifr to pio- 
linde its blood, the s,>id little bl.iddei with an 111 it w.is dilated and con- 
t Hilled 111 siieli a mot 1011 abo\e I full lionis tom'tliei Ihoinrh indeed 111 the 
last honi it was so l.iiiit, that one (ould lint pist peieeiie it , and .is toi the 
hcait, its motion w.is diseontiimed 




I also look a pike-fish, ahout 2 ieel loiifi:, and opened it immediateh 
Avhilc it WMs 111 its Jnll stieiifrlh oi life and obsened not onh the motion 
of the lieait, and the icgukii motion ot lli.it ]iait which iceenes the blood, 
and bungs it into the hcail, but .ilso the motion ol that othei pait, which 
leceives the piotiuded blood ficim the lieait, and caiiics it gentlv into the 
aiteiies 

Fig 23 , show's the heail of a pike, FFFA lepiesents that pait into 
W'liieh the blood is bionght liom the leins, and CDG, that othei pail which 
leeeives the blood horn the heail, to cam into the niiciics N^ow when 
the heait leceives the blood w'liieh is coineicd into it, it dilates to its ut- 
most loundness, and then that vessel leinesented by ADEF at that len 
instant collapses, and clischaigiiig its blood into the vessel, CDG, this be- 
comes distended by the sudden pouiing 111 oi the blood, and no soonci is 

[ 322 ] 



it so dilated, but it coiitiacts again, that it may foice the blood into the 
arteries In shoit, when ADBP is coiiti acted, and tliiows the blood into 
the lieait, this is dilated, and when the lieait contiacts and dischaiges the 
blood, CDG is dilated and these thiee seveial motions happen in so shoit 
a time, and are perfoimed so legulailj’-, that it is quite suipiising and 
from hence we cannot but conclude, that such a motion as this could not 
be bi ought about, unless the vessel ADEP had a valve at AD, wheie it is 
joined to the heait, which valve is to pi event the blood, that is tin own 
into the heait, fiom letuinmg the same way And so likewise theie must 
necessarily be anothei valve at CD, to pi event the blood, that is pi oti tided 
fiom the heait, fiom flowing back again 

Also Fig 24 lepiesents the heait of a salmon, wheie KLM shows that 
mstiument or vessel that was lepiesented in Pig 23, by ADEP, as INO 
shows the same as CDG in the said figuie 

Also the mstiument KLM being cut open, to discovei with the naked 
eye, the sinewy paits and their blanches, these appeared as in Fig 25, in 
which QR IS the pait that was joined to the heait, and is the same that in 
Pig 24 is lepiesented by KL , in the said Pig 25, we may obseive how the 
Sinewy parts and then blanches luii fiom QR to T This instrument, oi 
vessel, is veiy soft in its pails, and it seemingly is not stioiig 

Pig 26 IS that vessel dissected, which m Pig 24 is lepiesented by ION, 
which vessel is exceedingly thick and stioiig, and like that lepiesented in 
Pig 25, piovided with stioiig siiievy paits, that when the parts aie ex- 
tended by the blood pouied into them, they may be able botli in round- 
ness and length to convey the blood into the aiteries these paits, bv 
leason of then gieat numbeis, cannot be delineated in such mannei as 
they ought to be 

Pioni the nhole I conclude, that the heait piotiudes the blood gently 
into the aiteiies, and that the blood, which flows from the veins into the 
heait, causes that sudden levulsion, called the pulse, both because it can- 
not so immediately pass tlnough the valves, and because the veins in that 
pait aie a little naiiowei, bv which means theie is a kind of stop oi nitei- 
mission in the eneulation of the blood and tins I conceive is the cause of 
that motion which ve call the pulse ' 


*n IS scucoh ncccssii\ to lomiiK thnt Mr L’s conjectuics 
mu niturc of the pulse iie e\tiemeU enoneous and absuid 


respecting the cause 


The ibo\e footnote piobabh leas \MUten be eithci Di George sili i\\ or Dr Picliaid 
.lAo'Pr 'PH’ ChuKs Hutton ibiidgcd the Phtlo^ophwnl Tian^futions in the < ditlon 
li'Ut) fiom which \\c h i\o repiinltd l^tuwtnhocK s communication A W 1910 


[ 12 -'] 




1733 

early expert! ^^^es 

«ESTU„5 




STEPHEN HALES 
Portrait liy Thomas Hudson 


(Courtesy Chailes C Thomas ) 



STEPHEN HALES 

(1677-1761) 

0 N SEPTEMBER 7, 1677, Stephen Hales was horn at Beckeshourne, Kent, Eng- 
land He was the sixth son of Thomas and Mary Hales His paternal grand- 
father, Sir Robert Hales, was created a baronet by Charles 11 

At the age of nineteen, young Hales entered the University of Cambridge as a 
pensioner of Corpus Chnsti College He was graduated from that college with the 
degree of Bachelor of Arts in 1696 He then accepted a fellowship which he held for 
several years In 1703 he received the degiee of Master of Arts In 1704, still at 
study under his fellowship, he made the acquaintance of William Stukely (1687-1765), 
who had come to enroll at Corpus Christi College Stukely and Hales became friends 
Both were interested in natural history, anatomy, and chemistry They spent con- 
siderable time together, sometimes collecting fossils and sometimes in quest of but- 
terflies They also studied comparative anatomy and the dissection of frogs, dogs, 
and other animals Among other activities they found time to repeat many of 
Boyle’s classic experiments 

In 1710, Hales was made perpetual curate at Teddington in Middlesex There he 
was ordained in the ministry and in 1711 he received the degree of Bachelor of Di- 
vinity Hales made Teddington his home for the remainder of his long and useful 
life He was a very faithful minister and his scientific interests were reflected in 
his curateship Among other things, he aided his parish in obtaining a pure supply 
of water, helped construct the church lantern, and replaced the timber tower that 
held the lantern with a tower made of bnck He requested that at his decease, his 
remains be placed beneath this tower 

Some time after he was made curate he was marned to Mary Newce, the daughter 
of Dr Newce, rector of Halisham She died in 1721, leavmg him no children 
In 1718 he was elected a fellow of the Royal Society of London and in 1719 he 
reported before the society the results of some expenments he had made on the 
effects of the warmth of the sun in raising the sap in trees 

The Royal Society encouraged him to continue his researches, which Hales did 
with much enthusiasm His combined efforts were published m 1727 in a volume 
entitled “Vegetable Staticks, or, an account of some statical Expenments on the 
Sap in Vegetables bemg an Essay towards a Natural History of Vegetation, also 
a Specimen of an Attempt to analyse the Air by a great Vanety of chemio statical 
Expenments, which were read at several Meetings of the Royal Society ’ ’ 

Hales published a second edition of this work in 1731 In the preface to the new 
edition he promised to contnbute a second volume contammg more of his studies 
This appeared in 1733 under the title “Statical Essays contammg Haemostaticks, 
or an Account of some Hydraulick and Hydrostatical Expenments made on the 
Blood and Blood-Vessels of Animals, also an Account of some Expenments on Stones 
m the Kidney and Bladder, with an Enquiry into the Nature of these anomalous con- 
cretions To which is added an Appendix confaming Observations &, Expenments 
relating to several Subjects m the first Volume ’ ’ 

From the second volume of Hales’ important work it is our pnvilege to repnnt 
his classical expenments wherem blood pressure and velocity were first measured 

[ 327 ] 



In his Arst experiments Hales placed a vertical glass tuhe, the Arst manometer, in 
the artery of a horse and measured the distance the hlood rose to determine its 
pressure He performed similar experiments upon the sheep and the dog Much 
later, Jean Marie Polseuille (1793 18G9) and Karl F W Ludwig (1816-1895) were 
to measure hlood presstiro hy the means of a mercitrj manometer This in turn was 
to he followed hy the kymograph of Ludwig and led to the present graphic methods 
now In use 

Hales estimated the hlood pressure in man to ho about T'/; feet, oxpre'^sod ac 
cording to his system of measurement This is somewhat high, of course, hut when 
wo consider the cnidlty of his Instniments and the fact that his work was done on 
experimental animals only, it seems to he a romarkahlo approximation 

Because of his “Statical Eesajs,” Hales achleacd an international reputation 
In 1733 he received the honorarj degree of Doctor of Dialnitj from the Universitj 
of Oxford In 1739, in recognition of his man> achleaements, Hales was awarded 
the Copley medal That same jear he puhllshcd a verj Instructive work which he 
dedicated to the Lords of the Admiraltv It was entitled “Philosophical expen 
monts containing useful and necessarj Instnictions for such as undertake long 
Voyages at Sea, showing how Salt-water maj ho undo fresh, wholesome, and how 
Fresh Water may he preserved sweet, how Biscuit, com, Lc , may he secured from 
the Weevil, Maggots and other Insects, and Flesh preserved in Hot Climates hy 
salting Animals whole, to which is added an account of Experiments, and Ohserva 
tions on Chalyhoate or Steel waters, with some Attempts to convey them to distant 
places, preserving their virtues to a greater degree than has hitherto been done, 
likewise a proposal for cleansing awa> Mud, out of Bivors, Harbours, and Beser- 
voirs ’ ’ 

In 1741 Hales, Sutton, a coAcc house keeper, and Martin Tnew.ald, a captain of 
mechanics to the Ellng of Sweden, had independently invented much-needed ventilat- 
ors for the purpose of removing contaminated air from the lower decks of ships 
Tho story of Tricwald’s invention was read before the Boaal Society in 1742 In 
1743 Hales’ work on ventilators appe.arcd His apparatus was similar to Tncwald’s 
It consisted of a large bellows which sucked out the foul air and could be operated 
either hy hand or hy windmill Sutton’s apparatus operated on a dUTcrent pnnciple 
It drew oA foul air hy the means of the cook-room Are It was of simpler design and 
replaced, to a large extent, the machines of Triewald and Hales In a few years 
ventilators were also used for prisons and hospitals Use of them resulted in reduc 
mg the death rate in these institutions, a rate which, hitherto, because of most un 
sanitary conditions, had been terrifically high 

Hales was honored with the friendship of Frederick, France of Wales He also 
was on intimate terms wath Alexander Pope, who was a neighbor 

He died on January 4, 1761, at the age of eighty-four In accordance with his 
wishes his remams were placed in a vault in the vestry under the new tower he had 
constructed for St Mary’s Church in Tcddington A monument to his memory was 
erected hy the mother of Geoige H, tho Princess Dowager of Wales It stands in 
Westminster Abbey in London 


[ 128 ] 



STATICAL ESSAYS: 

CONTAINING 

HiEMASTATICS; 

Or, An Account of fomc 

HYDRAULIC and H YDROSTAT ICAL 

EXPERIMENTS 

MADE ON THE 

Blood and Blood-Vefiels of As'IImals. 

ALSO 

An Account of fome Experiments on Stones 
in the Kidneys and Bladder 5 with an En- 
quiry into the Nature oPthofe anomalous 
Concretions 

To which IS added, 

An appendix, 

CONTAINING 

OBSERVATIONS and EXPERIMENTS 
relating to feveral Subjects in the Firll Volume The 
grcatell Part of which were read at feveral Meetings before 
the Roy\l Society 

With an INDEX to both Volumes. 

VOL ir. 

Drjiitralur Pbtlofofhia Naturahs vera t? aUiva, cut Midicira 
Scicntta tradificetur Fran dcVerul InHaur Magna 

By STEPHEN HALES, DD FRS 
Rector of Farringdon, Hamtshire, and Miniftcr of 
Teddington, Middlefex 

The T H I rd Edition, Correflcd 

L O N D O N, 

Printed fer Wilson and Nicol, in the Strand, T Durham, 
near Channg Crofs , G Keith, in Grace church Street , and 
Robinson and Roberts,^''. S5, m Pater>nollerRow. 1765 



TO THE 


KING’S 

Mo^t E\clIIuu 

SiH 

oiu ^laioslx s m.Kious of nu foiinci Volume of 

E\pcnniciits, ii.is eiu'oui.mctl aio. holh iuiduM lo puisue these 
iialuial H'S(Mi{iies and .ilso lo l.i\ Ilia jtsiill oi them .il ■soui 
feet 

The sliu]\ oi naluK' ■will e\ei a leld ns flesh anil lei of enloitain- 
nienl, and we lia\e frieat le.ison lo bless lind loi the fadiUics and 
abilities be has "i\en ns. ainl llie siionir desne be bas niiplaiilcd 
in om iiiinds, lo seaii'li into and eonlemplate Ins woiKs, in winch 
the faitbei wc a:o, tlie nioie we see tin* sitrnalnies of Ins wisdom 
and powoi. e\enlbnnr ideases and inslnnls ns, lieeansc in c\ci\- 
lhin<r we see a w ise desifrn 

As Ibo beanlilul labile of Ibis woild w.is dnelh ii.niied foi 
and .id.ijited lo llie ns<* ol man so the Kieatei insmbt we yet into 
llio natiue and inojieitu's ol lliinys, so niueli Ibe inoie lieiicficial 
will lbe^ be to us ibe nioie will oiii leal nebos Iheicbs nicicase, 
the iiioie <ilso will man’s oiiyin.il yianl ol dominion o^cr the 
01 cat 111 cs be inlaryed 

Yom Jfaicsh s snbieels of (lieal Eiit.nn aic allowed, In the 
eaiidid eonlession oi olbei nations, to e\cel in c\peiiniontal philos- 
opln, which bas long been lound lo bo most beneficial lo man- 
ic in d 

As the ad^aneenient ol ails and sdenees innch do]icnds on the 
piolcction of piniccs, whose palionayc lliev aie well woitln of, so 
w’e ha\e a pleasing jiiospect of their tlomislnng iiiidci jour 
Ma.iesly’s auspicious taAOiir, Aibosc caic and coiicoin loi the wel- 
faic and lllospcllt^ ol Ins people, is ni c\ciy icspcct most c"^- 
tensivc 

That loiir !Ma]eslv, after Inning long continued a blessing to 
youi snbieels in a piosperous leigii licie on cnitb, niav heicaftci 
en,ioy a happy ininioitalitA in bea^en, is the sinceic pla^cl of. 

May it please ioui j\ra,icslv, 

Yoiii i\la,iest3 's 
]\Iost humble and 
Dull till subiecl, 

STEPHEN HALES 


[ 330 ] 



AN ACCOUNT OF SOME 
HYDRAULIC and HYDROSTATICAL 
EXPERIMENTS 
MADE ON THE 
BLOOD and BLOOD-VESSELS 
OF 

ANIMALS^ 

EXPEEIMENT 1 

1 TN Decembei I caused a mmc to be tied down alive on liei liack, 
she was 14 hands high, and about 14 yeais o± age, had a fistula on liei 
withers, was neither veiy lean nor yet lusty having laid open the left 
crural arteiy about 3 inches fiom liei belly, I inseited into it a brass pipe 
whose bore was % of an inch in diameter, and to that, by means of an- 
othei biass pipe winch was fitly adapted to it, I fixed a glass tube, of 
neaily the same diametei, which was 9 feet in length then untying the 
ligatuie on the aiteij’^, the blood rose in the tube 8 feet 3 inches peipendicu- 
lai above the level of the left ventiicle of the heait but it did not attain 
to Its full height at once, it lushed up about half way in an instant, and 
afteiwaids giaduallj^ at each pulse 12, 8, 6, 4, 2 and sometimes 1 inch 
when it was at its full height, it would use and fall at and aftei each pulse 
2, 3, or 4 inches, and sometimes it would fall 12 oi 14 inches, and haye 
theie foi a time the same yibiations up and domi, at and aftei each pulse, 
as it had, when it was at its full height , to which it would rise again, after 
foity 01 fifty pulses 

2 The pulse of a hoise that is well, and not teriified, nor in any pain, 
IS about 36 beats a minute, which is neaily half as fast as the pulse of a 
man in health this male’s pulse beat about 55 times in a minute, and 
sometimes 60 oi a 100, she being in pain 

3 Then I took away the glass tube, and let the blood fiom the arteii 
mount up in the open an, when the gieatest height of its jet was not aboie 
two feet 

4 I measuied the blood as it lun out of the aiteiy, and aftei each quait 
of blood was lun out, I lefixed the glass tube to the aiteiv, to see how 
much the foice of the blood was abated, this I lepeated to the eighth 
quait, and then its foiee being much abated, I applied the glass tube aftei 
each pint had floved out the lesult of each tiial vas as is set dovn in 
the following table in which aie noted the gieatest heights it i cached 
aftei e\eiv e\acuatioii It was usuallv about a minute befoie it lose to 
these seieial heights, and did not use giaduallv but would stand dining 

•ThU worK oiiKinnlh ippoinnl in 173S Mt, 1 ji\o from edition of ITC^^ 

tlu iitle pigc of winch on piR«- — "h \ 

[ 111 ] 



se^elal pulses much lo\sei, lli.iii wli.il il %\()!il(] at length leaeh to, so that 
I otteii thought it had done iisuig, \\Iien on a sudden it Asould use for 
sometime, 4, S, 12, oi Ih imhes hmhei, ^\llele it Awmld slaj foi sometime, 
and then ou a sudden tall 1, S, 12, oi 16 imhes 


*Tlicso fi\o ounces lost in pro 
pnnng the nrtcr^ 


B;^ tins time there is n pint lost 
in innhiug the so\criiI tnuis whuh 
IS not 01101% cd for m this t ihlo 


The 

overal 

tnnii 

’I'Ik rjUiintitiCH of 
!»loo(l h t out Ml 
y MIC iiicii'.uri* 

Tiie scieral 
heights of the 
blood after thc'i 
('latuations 


(^uurt'? 1 

Bints 

I'cct 

Inches 

1 

0 I 

'3 ounce' 

8 

3 

<> 

1 

0 

t 

8 

n 

» 

~ 


t 

2 

1 

> 


G 

G>/. 

3 

1 ! 


C 

loyj 

r. 

5 


G 

V' 

7 

<> 


•3 

S’i 

s 

7 


1 

8 

0 

S 


O 

t 

.3 

10 

S 

3 

; 


11 

0 

0 

t 

10 

12 

0 

1 

1 

1 oy. 

1 . 

10 

0 


ou, 

11 

10 

1 

1 

sy] 

13 

11 

0 

I 

) 

8 

1(. 

11 

1 

! 

loy- 

17 1 

12 

0 

O 

9 

IS i 

12 

1 

♦ 

7«' 

30 

1 J 

0 


o 

20 

1 . 

1 

1 


21 

11 

0 

rs 

> 

0 

Oo 

*• w 

11 

3 

» 

3 

21 

33 

0 

3 

4yj 

21 


1 

*> 

<> 

1 

2 "^ 

30 

0 

O 

1 


Tlieie ttas about .i qua it lost in makino; the scteial tiials, so theic 
flowed out in all 17 quails, and half a jmit iiltei the last tiial, A\hcn she 
expiied This whole quantity of blood yas equal to hOGlS ciihick inches 

5 We may ohseive fiom this table, tlmt tlie dceicasc of the foicc of the 
blood in the ai tones, was not piopoilioned to the scteial quantities of 
blood which weie e\acnated, foi at tlic eighth tiial, yhen 7 qiiaits ycic 
diawn off, the height of the blood yas foni icet S inches, aftei yhich it 
decreased in the five following trials to thiee feet odd inches, sometimes a 
little lowei, and then a fey iiichas liigliei But at the foiutcenth Inal, 
aftei ten quarts and a pint had been diayn oft, it lose again up to foiu 
feet, 3 plus one-half inches, and it came iicnily to the same height again 
at the twentieth tnal, when thiitcen qiiaits and a pint had been diayai oft 

6 This dispiopoitionate inequality in the seveial heights y as pniicipally 
owing to her violent stiaining to get loose, y4iieh made the blood ni the 
foniteenth tnal use liigliei tlian it bad done in several of the preceding 
ones 

7 About the twentieth tnal slie grew very faint and uneasy, and 
breathed quick, the violent straining to get loose, did, by tlie acting of 

[ 132 ] 











most oi her muscles, especially the abdominal, imjiel the blood fiom all 
paits to the vena cava, and consequent!}’' theie was a greater supply for 
the heait, which must theiefoie thiow out more at each pulsation, and 
theieby increase the force of the blood in the aiteiies 

8 For the same leasoii, too, it ivould be somewhat inei eased in height 
upon deep sighing, because the lungs being then put into gi eater motion, 
and 11101 e dilated, the blood passed moie fieely, and in greater quantity, 
to the left amide, and thence to the ventiicle 

9 Tins plainly shows how sighing inci eases the force of the blood, and 
consequently, piopoitionably cheais and lelieves natuie, when oppressed 
by its too slow motion, which is the ease of those who aie dejected and sad 

10 Hence, also we see evidently, that the blood moves fastest and most 
freely tin o' the lungs when they aie in a dilated state for which leason 
annuals when they aie near expiring, do usually breathe quick, the lungs 
then laboiing to heave fast, that the languid blood may theieb}'-, have a 
freer course thro’ them, to supply the then almost bloodless pulsations of 
the heait, as was, we see, the case of this maie when her blood was near 
exiiausted 

11 When between 14 and 15 quarts of blood had been evacuated, and 
theieby the force of that which remained in the vessels greatly deci eased, 
then the maie fell into cold clammy sweats, such as frequently attend 
dying persons, which shows to how low a state the vital force of the blood 
IS at that time i educed Whence we see, that these faint sweats aie not 
occasioned by a greater piotiusive foice of the blood at that time, but 
rather by a geneial relaxation of the poies, as well as of all other parts of 
the body And it seems hence probable, that the vigour of the blood in 
the arteries is much abated, when persons who are not iii a dying state, 
have colliquative sweats, as in violent colic pains, fear, &c 

12 Uiion opening the male’s body, I found little or no blood in the 
flojfa, about an ounce in the left ventricle, but none in the right, the 
vena imita and cava were full, she bled two or three ounces, but very 
slowly, and not without pressing the jugular vein, which was opened as 
soon as she expired 

13 There might be about tvo quarts and thiee-quaiteis of blood left 
in the large reins, uliicli, nitli nliat uas diavn out at the artery, makes 
fire vine gallons, 11111011 at 221 ciibick inches to the gallon, amounts to 
1105 ciibick niches, 01 42 2 pounds, which, at a low estimation, may be 
reckoned the qiiaiititi of current blood in a hoise, there is, doubtless, con- 
sider ablv more, but it is not easy to determine hoii much 

14 As this expeimient sheiis how much the foiee of tlic blood in the 
ai tones is abated bv difieient degrees of eiacuation, so it mav be of use 
to dnect iihat quantitv to let out at a time in bleeding foi iihateiei the 
leal quantiti of the ciiculating blood be it is ccitain that the estimate of 
what can with safeti be let out at once must be taken fiom the piopoi- 

1 3 - ] 



tion which that bcais to the in hole qiianliti of hlood, mIucIi Mill flow out 
of the vein oi aitery of the animal till it dies 

15 We sec also fiom this expeiimcnt, the i casonahleness of the piac- 
tice of bleeding at seieial distant times, vheie it is lequisilc to take ai\ai 
a gieat quantity of lilood, and not to do it all at once, i\lnch Mould too 
much M^eaken the foicc oi the blood Foi since it Mas found bj se^elal 
instances in this expeiimcnt, that mIicii the ioiec of the blood Mas much 
depiessed bv eiaeuations, it Mould he eonsideiabh laiscd again In the 
action of the muscles, out of mIiosc ^cl^ fine and long capiliai\ acsscIs it 
moves but sIomIv, as also In the motion of all pails of the mnic, so the 
case IS doubtless the same, mIicii the muoui ol the blood is in am deaiee 
lebated in the huge lessels, In blood-let 1 in that Mgoiii Mill in some 
measuie be in a little time lostoicd again not onh In the action of the 
seveial paits of his bod\, Mhcieln the blood Mould ha\c time to floM in 
fioni all paits, to supph the most oiacuated ics.sels Mheidn theie Mould 
be a ]ust piopoilionatc ciaeuation of all paits, but also because the les- 
sels themsches Mould thcicln ha\e tunc to contiaet thcmschcs in some 
piopoitioii to the degioo of then ciaeuation 

EXPEh'nfJ'JNT 11 

1 In Jaiiuaiv, I caused a qchhnq to be tied down last on his back, m 
the same manner as the maie was in the loicgoing expenmont he Mas 
13 hands high, and 10 or 11 ^oals old but ^cl^ lame, bv leasoii of a caiikei 
in his hoof, he wxns loan, but somcMhat lustier than the male, and imieh 
moie lively I fixed the same biass pqic and glass tube, ns abo\e, to his 
left ci 111 al aitei> 

2 The blood luslicd up the tube at once, to neai two-thnds of its gicatcst 
height, and then inoie Icisuielv, as in the maie It Mould use and fall 
commonly, about an inch at each pulsation ol the heait but sometimes tMO 
01 thiee niches I let out the blood giaduallv, as in the maic, and aftei 
each evacuation, I lefixed the glass lube to the aitoii, to take the se^elal 
heights of the blood the icsult of caeli tual was, as noted in the following 
table [See opposite page ] 

3 When I fiist fixed the tube to the aitcii, I stopped tlie lioisc s 
nostiils, so as to make him bicathe Muth gicat difficult ^, wdiich made the 
blood use five inches higlici, but I could not cam this expciniienl almost 
to suffocation, as I wmiild have done, because his plunging obliged me to 
take the tube fioin the aitery lie did not bleed hall a pint iiioic aftei tins 
last tiial, befoie he expiied 

4 We may obseive that as this hoise wms iiioic Inelv than the niaie, 
so the blood mounted at the fiist tiial 17 niches liighoi in the tube, than 
the male’s blood did, yet theie flowmd tliiee pints of blood less fioni the 
hoise than fiom the maie, one leasoii of this may bo, that as she wms 4 
inches tallei, than the hoise, so she Mxis piobably piopoitionably biggei 

tl‘54] 



m size eveiy way, and should theiefoie have moie blood, besides, bulk 
for bulk, the females aie obseived to have moie blood than the males 

5 As the quantity of blood decreased, so would the piojectile force of 
the blood in the tube piopoitionablj'- deciease, so that it would not use 
above a quaiter of an inch at a pulse, when the hoise giew veiy faint 

6 The gieat ascents oi descents of the blood, vts 12 oi 15 inches at a 
time, did not seem to be owing immediately to the moie vigorous oi faint, 
faster oi slower pulsations or systole of the heart, but by its continued 
equable beating, seemed ratliei to be occasioned by a more or less quantity 
of blood flowing in to supply the left ventiiele of the heait 


The seveial 
tiials 

The quantit-y ot blood let 
out 

The seveial heights o± the blood 
aftei tliose ei acuations 


Quaits 

Pints 

Feet 

Inches 

1 

0 

1 

9 

S 

2 

1 


9 

8 

3 

2 


9 

SVj 

4 

3 


S 

4 

5 

4 


8 

2 

6 

5 


7 

814 

7 

6 


7 

1 

S 

7 


7 

Gt4 

9 

8 


7 

4% 

10 

9 


6 

ey. 

11 

10 


6 

7% 

12 

11 


5 

11 

13 ^ 

12 


5^ 

81/2 

13 ^ 

12 


4t 

5% 

14 

13 


4 

4 

15 

14 


3 

8 

16 i 

14 

1 

4t 

2 

1 

14 

1 

85 

2 

17 

15 


3 

3V2 

IS 

15 

1 

2 

10 


‘The highest point it w ould stand at for some time 

tThe loivest points at which points it ■would continue for some time 

$The higliest point 

§The lo-west point 

7 Tile hoise’s pulse beat 40 stiokes in a minute, befoie he was distuibed 
01 tied down, but when the glass tube was fixed to the aiteiy, it beat 65 
in a minute, and as the lioise giew faintei, tlie pulse vas moie and moie 
aceeleiated, so as to beat an 100 times ox moie in a minute, vhenee ve 
see, that the pulse is veak and quick, wlieii the heait is supplied vith little 
blood, vhich is the case in the hectic fe\eis, etc 

8 And the diastole of the heait must nccessaiily be piopoitionabh 
small, foi if the heart dilated as much, vhen a small quantity of blood 
flowed into the ^ent^lcle, as when a huge quantitv enteied it must then 
consequentlv be filled paitlv with an each time, which A\ould soon cause 
the death of the animal 


rxPi:i?iu/jxT in 

1 In Dcccmbei I hud a common field gate on the giound with some 
stiaw upon It on which a white inaic was cast on hei inrht side, and in that 

f m5] 





the enteiing Avax, and I did the same also at the onfice of the aoiia, wheie 
the valves called semtluncues weie also piopelled imvaid by the above- 
mentioned mass vent-pipe 

15 And this is the piopei cavit 5 ^ of the left A^entiicle, just befoie its 
conti action , foi at that instant, the blood flowing in from the aiiiicle has 
opened the initial valves inivaid, ivhile at the same time the eonti acting 
aiteiies lepel the blood foieibly against the semilunai valves, but at the 
instant that the ventiicle conti acts, the mitial valves are closed, being 
expelled by the blood oiitwaids, v^hile at tlie same time tlie semilunai are 
by the same action opened outwaids, to make way foi the compiessed 
blood to lush into the aoita 

16 So that this piece of wax tlius foimed, may leasonably be taken to be 
iieaily eommensuiate to the quantity of blood leceived into this ventiicle 
at each diastole, and is tlienee piopelled into the aoita at the subsequent 
systoles 

17 Having theiefoie filled a naiiow-mouthed vessel bum-full of ivatei, 
I immei sed the wax in it , then taking it out of the watei , I filled the vessel 
biiin-full again, fiom anothei vessel, whose capacity was divided into cubick 
inches, which gave the bulk of the ivax, and consequently the capacity of 
the left ventiicle, equal to ten cubick inches 

IS I got the quantity of the suiface of tlie sides of this ventiicle by lay- 
ing pieces of papei aptly cut to the iiiegulai foim of tlie sevcial paits of 
the Avax, and then laying those papeis undei anothei paper, Avhicli Avas 
equally dnnded into little squaies of one-fouith inch each, by i mining a 
pin thio’ both papeis at eA^eiy eoinei of each squaie, the undei papeis 
being thus maiked too, it AA'as easy by nunibeiing then seA^eial squaies 
and paits of a squaie, to come pietty neaily to an estimate of the Avdiole 
inumid suiface of the ventiicle, aa^IucIi I by tins means found to be equal 
to 26 squaie inches, deducting one squaie inch foi the aiea of the oiifice 
of the aoita, Avhose diainetei I measuied fioin the injected AA^ax 

19 The diametei of the aoita just befoie the coionaiy aiteiy branches 
fiom it, AA^as 1 15 inch, Aidience its aiea 1 036 squaie inch 

The diametei of the descending aoi ta 0 93, its area 0 677 

The diametei of the ascending aoi ta 0 74, its aiea 0 369 

20 The inAvaid aiea of the sides of the left ventiicle being therefoie 
equal to 26 squaie inches, the sum of the aaOioIc piessuie of the blood 
against all the sides of that ventiicle, at tlie instant Avhen it begins first to 
conti act, so as to sustain the piessuie of the aiterial blood, aauII be that 
suiface 01 aiea multiplied into the peipendiciilai height of the blood in the 
glass tube, vis 26 x 114 inches, viz 2964 cubick inches of blood 

21 And since, according to Di Juiin’s estimate, in Motte s Abiidgment 
of the Tiansaetions, pait 2d, page 141, a cubick inch of blood Aveighs 267 7 
giains, these multiplied into 2964, the numbei of cubick inclies, and then 
leduced into pounds, give 113 22 pounds, Avhicli is the sum of the pressuie 

[ 138 ] 



of the blood, which this ventiicle sustains, at the instant iihen it is going 
to exeit a conti active foice, sufficient to piopel it with eonsideiable velocity 
into the ao't ta 

22 The scruple avoiidupoise contains 18 25 giains, the ounce 438 giains, 
the pound 7008 giains 

23 The aiea of the gieatest section of this ventiicle fiom apex to base 
being 6 83 squaie inches, these multiplied into 114 inches, the peipendiculai 
height of the blood, m the tube, give 778 62 cubick inches of blood, equal to 
29 7 pounds, the foiee of the blood which the musculai fibres in that tians- 
leise section of the ventricle must lesist 

24 The velocity with which the blood is tin own out of the lentiicle into 
the oiifice of the aoi ta, may be thus computed, viz the capacity of tins len- 
tiicle being equal to ten cubick inches, and the aiea of the tiansveise sec- 
tion of the aoi ta being 1 036, by which dividing the ten cubick niches, the 
quotient 9 65 is the length of the cylnidei of blood, which is toimed in 
passing till o’ the aoita’s oiifice, at each systole, of the ventiicle And a 
hoise’s ventiicle of his heait conti acting, oi his pulse beating 36 times in 
a minute, that is, 2160 times in an houi, then a column of blood so mam 
times 9 65 inches, oi 20,844 inches long, oi 1737 feet will pass m an hoin 

25 But the systoles of the ventiicle dining which that quantity of blood 
IS piopelled, being estimated to be done in one-thnd of the space of time 
between each pulse, the velocity of the blood dining each systole, will be 
tlnice as much, viz at the late of 5211 feet, i e , 0 98 of a mile in an lioin, oi 
86 85 feet in a minute 

26 Now this velocity is only the velocity of the blood at its fiist enteiing 
into the ao) ta, in the time ot the systole, in consequence of which the lilood 
in the aiteiies, being foicibly piopelled foiwaid, with an acceleiated im- 
petus, thereby dilates the canal of the aiteiies, which begin again to con- 
ti act at the instant the systole ceases, by which cuiious aitifice of natuie 
the blood is earned on in the finer capillaiies, vith an almost even tenoi 
of velocity, m the same manner as the siiouting ivatei of some fiie-engines 
IS conti ived to flow vith a moie even velocity, notwithstanding the alternate 
systoles and diastoles of the using and falling embolus oi foice, and this In 
the means ot a laige inveited globe, wheiein the compiessed an alteinateh 
dilating 01 conti acting, m eonfoimiti to the ivoi kings to and fio of the 
embolus, and theieb'\ impelling the watei moie equably than tlie embolus 
alone would do, pushes it out in a moie ncailv equal spout 

27 And since the blood in the finest capillan aiteiies, piesses into the 
\enis with a much moie equal lelocitv, than in the aoiia and gi eater 
aiteiies, since also the systole is supposed to be neaih one-tlmd of the time 
between pulse and pulse, the othei two-thuds oi that tune must be spent 
m the contiaetion ot the aiteiies it nun theieloie ie<isonablv be c on- 
eluded that the sum of the dilatation oi all the aiteiies in each systole 

f 1 10 ] 



IS equal to about tlie quantity of two-thiids of the blood, which is thio^vn 
out in each systole, which in the case of this inaie is equal to two-thnds of 
10 cubick inches, viz 6 66 

28 This ventiicle throwing out 10 eubiek inches at a time, will in the 
36 pulses of a minute thiow out 360 eubick inches, equal to 13 75 pounds, 
and in an houi 825 pounds Aveight of blood, neaily equal to the weight of 
the horse 

29 The aiea of the transveise section of the aoita being as above noted 
1 036 inch , and the immediate next divisions of it being in the aiea of the 
like section of the descending aoi ta 0 677 inch , and that of the ascending 
aoita being 0 369, we find the sum of the two aieas of these ascending 
and descending blanches is gieatei than that of the tiunk they aiise fiom, 
and aceoidmgly the velocity of the blood will be propoitionably abated in 
them, as also on account of what passes thio’ the coionary arteiies, before 
the blood ai lives at those two blanches, of which the descending aoita 
IS consideiably the laigest, theieby to furnish a gieatei quantity of blood, 
in the propoition that all the pails of the bodj’- below the heart exceed the 
bulk of those above the heait 

EXPEBIMENT IV 

1 I injected also with wax the left auiicle and ventiicle of an ox’s 
liemt, which ox was by guess supposed to weigh about 1600 pounds when 
alive 

The capacity of this ventiicle was equal to 12 5 eubick inches 

The area of the tiansveise section of the aotta equal to 1 539 inch 

That of the descending aoi ta equal to 0 912, that of the ascending equal 
to 0 85 

2 The pulse of a veiy gentle cow, which was not teiiified nor distiubed, 
while its pulse was counted, was at the late of 38 in a minute, nearly the 
same as that of a horse 

3 The capacity of this ventiicle 12 5 being divided by the aiea of the 
oiifice of the aoita 1539, the quotient 81 inches is the length of the 
cjdindei of blood, which is formed in passing thio’ the aoi ta, in each systole 
of the ventiicle 

4 And an ox’s pulse beating, or this ventricle conti acting 38 times in a 
minute, that is, 2280 times in an houi, then a column so many times 8 1 
inches, oi 18,468 inches long, oi 1539 feet, will pass in an houi 

5 But each systole of the ventiicle being perfoimed in one-thiid of that 
time, the velocity of the blood in each systole will be tin ice as great, viz 
4617 feet, le , 0 874 of a mile in an houi oi 76 95 feet in a minute 

6 This ventiicle throwing out 12 5 eubick inches at a time, will in thiity- 
eight systoles, which it peifoims in a minute, thiow out 18 14 pounds, and 
in an houi, and twenty-eight minutes, it will have thiown out 1600 pounds 
of blood, a quantity equal to the weight of the ox But this ox being fat, 

[ 140 ] 



a qiiantity of blood equal to his u eight must be loiigei m passing tlirough 
its heart, than m the lean lioise, Expei III No 27, for the fat of animals 
has little 01 no blood in it, whence, lean animals have caetens j)anhus 
much moie blood in them than fat ones 

EXPERIMENT T" 

1 I took an estimate also of the foice of the blood in a fat gelt sheep or 
wethei, by fixing glass tubes to the .lugulai vein and carotid aiteiy, in the 
same niaimei as I had done to the hoise in Ex]ier III The sheep was thiee 
yeais old and weighed ninety-one pounds alive 

2 Its pulse beat 65 times in a minute 

3 The blood rose in the tube fixed to the jugulai vein 5 + inches, and 
9 inches when the sheep stiuggled and stiained 

4 In the tube fixed to the caiotid aiteiy it lose 6 feet 5 + 1/2 inches 

5 The capacity of the left ventiicle of its heart, ivas equal to 1 85 cubiek 
inch 

6 Its inwaid suiface == 12 35 squaie inches 

7 Its greatest tiansverse section = 2 54 

8 The aiea of the tiansverse section of the aoita = 0 172 squaie inch, 
that of the descending cioita === 0 094, that of the left caiotid aitery — 
0 012, and of the light = 0 07, they both lose sepaiate immediately fiom 
the aoita 

9 The iiiwaid suiface of this left yentiicle being equal to 12 35 squaie 
inches, this, multiplied by 6 feet 5 + inches, pioduces 957 12 cubick 
inches of blood = 36 56 pounds, the i\ eight of blood which this ventiicle 
sustains, .pist befoie its systole begins 

10 And the area of its gieatest tiansieise section being = 2 54 squaie 
inches, this multiplied into 6 feet 5 + 1/7 niches, the height of the blood 
m the tube, the pioduct is 196 85 cubick niches of blood = 7 51 pounds, 
the weight of blood which the filiies in this tiaiisieise section of the len- 
tiicle must sustain 

11 The capaciti of the left \entiicle being = 1 85 cubick inch, which 
dnided bv 0172, the aiea of the tiansierse section of the aotfa, the 
quotient 10 75 is the length of the eylindei of blood, which is foimed in 
passing thio’ the aoi ta in each systole of the leiitiicle 

12 And this sheep s pulse beating, oi Ins left lentiicle conti acting 65 
limes 111 a minute, that is 3900 times in an lioui, theiefoie a column of 
blood so mam times 10 75 inches, oi 41,925 inches long oi 3493 75 feet 
w ill pass in an hoiii 

13 But the sysiolcs of the heait, dining vlncli that quantitv of blood 

IS piopelled, being estimated to be done in one-thiid of the space of time 
between each pulse the lelocitv of the blood dining each st/^iolc mil be 
thnee as much at the late of 10 481 25 feet, ic . 1 98 mile in an 

lioui. 01 174 6 feet in a minute 


ftni 



14 And the ventiiele tin owing out 1 85 cubick inch oi blood each time, 
that will be 4 593 pounds in a minute, oi 91 pounds, a quantity equal to 
the weight of the sheep in twenty minutes 

EXPEBIMENT VI 

1 Having fixed a tube to the left criual aiteiy of a falloii; doe, the blood 
lose 4 feet 2 inches in the tube 

2 I injected ivitli wax both auiicles and ventiieles of the lieait, of 
another doe, and found the capacity of the ventiicle equal to 9 cubick 
inches, and the light auiiele and ventiiele neai as big 

3 Timoious animals aie oiiscived to have laigei Iieaits than courageous 
ones, as deei, asses, haies, etc which liolds tine in the instance of this 
doe’s heait Qu May not one leason ol this be, that the flbies of the 
timoious aie geneially moie lax than those of couiageous animals^ On 
which account the blood passing with less lesistance thiough the lax 
fibied eapillaiy vessels, it was lequisite that the heait should at each 
pulse thiow out a gieatei quantity of blood, in oidei to supply its more 
easy and plentiful flow thiough the lax eapillaiy arteiies into the veins 
And may not this be the leasoii why the pulses of young animals, as of 
childien, aie found to beat faster than those of grown persons^ viz be- 
cause the tender fibres of the coats of then blood-vessels being very lax, 
they give the less resistance to the flowing blood, whose globules aie ob- 
served by Leewenhoeck to be all of a size both in great and small animals, 
whence it was needful to make provision for a piopoitionably greater 
supply of it from the heart, by nici easing the velocity of the dilatations 
and contractions of that cuiious engine, in the formation of which are 
seen such evident marks of the consummate wisdom of the great Author of 
nature 

4 The area of the tiansveise section of the aoifa of this doe = 0 476, 
of the descending aoi ta — 0 383, of the ascending == 0 246, and that of the 
pulmonary alter = 0 502 But it being not easj^ to obtain, in that timoi- 
ous cieatiue, the just number of pulses in a minute, I could not calculate 
the velocity of the blood, nor the quantity that passes in any detei inmate 
time 

EXPEBIMENT VII 

1 I fixed tubes also in the same mannei to the jugulai vein and carotid 
artery, of several dogs, for whatever experiment I principally intended to 
make on any dog, I usually began with fixing a tube fiist to the jugular 
vein, and then to the caiotid aiteiy, which was the method I used to wash 
the blood out of the capillary vessels, thereby the better to prepare them 
for my intended experiments 

2 The force of the blood in the veins and arteries is very different, not 
only in animals of different species, but also in animals of the same kind, 

[ 142 ] 



and that not only in those of diffeient sizes and weights, hnt also in dogs 
of tlie same size and weiglit, and even in the same animal, the force of the 
blood in its vessels is eontinually vaiving, accoiding to the diffeient kinds 
and quantities of food, the vaiious distances of time aftei taking food, the 
moie 01 less plethoiic state of the blood-vessels, also fiom exeicise, icst, 
diffeient states of vigoui or vivacity of the animal, and many othei cii- 
cumstances, which may conduce to vaiy the toiee of the blood, foi the 
healthy state of animals is not confined to the scanty limits of one de- 
teiminate degree of vital vigoui in the blood but the all-wise Piamei of 
these admirable machines has so oideied it, as that then healthy state sliall 
not be distuibed bv eveiv little vaiiation ot this foice, but has made it con- 
sistent with a veiy considerable latitude in the vaiiation of it Nov since 
this foice of the blood is so vaiiable, it is the moie requisite to be fuinished 
with a good quantity of obseiv ations, theiebj'' to find out, the moie 
neaily, a medium of those foices, not only in the same animal, but also 
111 those of diffeient ages, sizes, and kinds, whence hapl}’’ some cuiioiis 
obseivations may arise 

3 These gieat inequalities of the foice of the blood, not only in dif- 
feient annuals, but also in animals of the same kind, may be seen in the 
following table in Expei VIII No 12 in whicli I have set down the 
weights of most of them, and also in diffeient columns, the height to 
which the blood lose in tubes fixed to the veins and aiteiies 

4 I obsencd lieie, as in the above-mentioned hoises, and that when 
the blood liad subsided a little in the tubes which weie fixed to the 
aiteiies of these dogs, it would as in the hoises, use on a sudden con- 
sideiably on deep sighing, as also on picssing the dogs bellies liaid with 
the hand, the blood would immediately use about six niches and subside 
as much on taking oft the hand, and it was the same on seveial lepeli- 
tions 

5 It may be objected to this method of estimating the foice of the 
blood, that by thus fixing tubes to these laige veins and aitenes, the 
eouise oi a considoiable stieam of blood was foi that time stopped, and 
that consequently the foice of the blood must be jnopoi tioiiablv' ni- 
cicased in all the veins oi aiteiies, and tlieiefoie also in the veins oi 
ai tones to winch the lube is fixed and doubtless in some degiee it is so 
In the sheep the left eaiotide is ncailv . pait of the light caiotide and 
descending aoiia taken togelhei , and in the dog. Numb 3. it is ,iboul 

of them 

(» To oliviate theiefoie this inconvenieiKC I fixed tubes lateiallv to the 
mgulai veins and aiteiies ol the dog Numl) 13 in the following mannei 
nr I took two evlindiital sinks wliicli weie ^ inch dianietei, and 1 - J . 
null in leimth and having boied holes thiouLdi them fiom end to end 
Munething lamei than those veins and aiteiies I then slit them in halvfs 

[ 1 -" 1 



length-ways, and boied anotliei hole thiough the middle ot one of them 
into its cavity, into which lateial hole the hi ass pipe enteied, which was, 
at its othei end, adapted to fit anothei pipe which was cemented to a glass 
tube Then having laid the vein oi aiteij’' baie, I dieiv a linen cloth undei 
it, to wipe it veiy diy , and then placed undei it one of the above-mentioned 
slit pieces of wood, laying the vein oi aiteiy in its cavity, which was 
covered with pitch, that was at that instant afiesh melted with a small 
warm non lod, then pouiing melted pitch not veiy hot, ovei the vein oi 
aiteiy, I immediately put on the othci half of the split wood, which had 
the hole boied thio’ it, and tied them fast together then enteiing the 
veij^ slendei point of a pen-knife into tlie above-mentioned hole, I cut an 
oiifice in the vein oi aiteiy, and then immediately fixed the biass pipe and 
tube to receive the following blood, which lose fiom the jugular vein of 
the thirteenth dog, first, six inches, and on stiaining 9 + 14 inches, and 
from the artery four feet eleven inches, and would doubtless have mounted 
higher, if the blood had not made an outlet between the artery and the 
pitch, so as to prevent its rise, which inconvenience might easilj^ be pie- 
vented by proper care, which, if done, would give us the real force of the 
blood against the sides of the aiteiies, as it did in this jugular vein 

7 I believe this would be a good method to take the force of the blood 
in lesser animals, where by reason of the smallness of those vessels it 
might be difficult to insert pipes into them, which if done, those pipes would 
have too small a bore for the blood freely to pass through them 

8 I have noted in the following table, Expei Numb 12, the 

several heights to which the blood rose in tubes fixed to the veins and 
arteries of animals, as they lay horizontally on then backs, or on one side, 
in the case of the mare, Expei III But when an animal stands on its 
legs, a column equal to the peipeiidiculai height of tlie animal, must be 
added to the several heights of the blood in the glass tubes, in order to 
estimate the force with which the blood pi esses against the coats of the 
blood vessels, at the lower parts of the body, and so m proportion for any 
other part that is liigliei So that these columns of blood in the arteries 
and veins, communicating ivitli each other, are, on account of then equal 
heights, equipollent to each other the progressive motion of them being 
determined by the energy of the heart And though valves iri tubes in 
which a fluid is propelled upAvards Avitli an equal force, ivould rather 
retard than promote its progress, yet in tubes where the fluid does not 
ascend equably but by reason of frequent motions of the ivliole machine, 
it IS subject to many agitations, in this case valves are of great importance 
to check the repercussion and regurgitation of the fluid, and accordingly, 
the all-wise Framer of animal bodies has provided valves in the veins, to 
prevent this inconvenience, and that principally in the lower parts of the 
body, where they are most needed, especially in great motions, and in 
exerting the muscular force of the body 

[ 144 ] 



EXPEBUIENT Till 

1 The blood having iisen six feet eight inches from the ciuial aiteiy 
of the dog, Numb 1 and to the same height fiom the left caiotide arteiv 
of Numb 7 111 the talile, Numb 12 of this Bxpeiunent VIII, I chose to 
calculate the velocity, &c of the blood of this dog 

2 The capacity of the left Amntiicle of the lieait, being injected ivith 
wax, was found equal to 1 172 cubicle inch 

3 Its inwaid suiface equal to eleven squaie inches, which multiplied 
into the iieipendieulai height of the blood in the glass tube, which ivas 
fixed to the aiteiy, viz six leet eight inches, oi eighty inches, gnes eight 
bundled and eighty cubick inches ol blood, which pi ess on all sides of that 
veiitiicle, when it has con ti acted just so lai, as to sustain and be equal to 
the foice of the blood in the ao) ta 

4 These eight huudied and eighty cubick inches multiplied by 267 7, the 
iiumbei of giains in a cubick inch ot blood, gives 235,567 = 33 61 pounds 

5 The aiea oi the tiansveise section ot the ao) ia, just beioie the coronaiy 
aiteries bianeh off tiom it, being 0193 squaie inch, by which dividing 
1 172 cubick inch, the capacity ot the Acntiicle, the quotient 5 978 inches, 
is the length oi the cjdindei ot blood, uhich is toimed in passing thio’ the 
oiifice of the aoj ia, at each systole of the ventiicle 

6 And a dog’s pulse being tound to beat, oi his left ventiicle to con- 
tiact, nmcty-seAcn times in a minute, then a column of blood so many 
times 5 97 inches long, i\ ill be 34,745 4 inches, oi 2,895 45 ieet long , but the 
systoles ot the heait duiing which that quantity is piopelled, being esti- 
mated to lie done in one thud ot the time between pulse and pulse, the 
leloeitA oi the blood duinig each systole will be tliiice as much, viz 
8,680 35 ieet, that is at the late oi 1 64 mile in an hour, oi 144 77 ieet in a 
minute 

7 And the Acntiicle thioving out 1172 cubick inch oi blood in each 
systole, that is, 4 34 pounds m ninetA-sc\en pulses, the numbei of pulses 
m one minute, hence fiiit>-t\\o pounds a quantity equal to the dog’s 
weight, will pass tin o’ the heait in 11 9 minutes 

8 It aeeouling to Di Keill’s estimate, the left Aentucle of a man’s 
heait thiow out in each systole an ounce oi 1 638 cubick inch of blood, 
and the aioa ol the oiifice ot the uoita be === 0 4187, then diMding the 
foimoi b\ this the quotient 3 9 is the length oi the cclmdei of blood, winch 
is ioimed m jiassnig lino the aoiia in each systole oi the Aenlncle, and 
in the scAcnlA-fnc pulses ot a minute a CAlindci ol 292 5 niches leimth will 
pa^s tins IS at the late oi 1462 ieet m an hoiii But tlie systole of the 
luait licmii poiloimed m one-thiid oi tins time the \elocilv of the blood 
m that instant will be thiice as much ic at the latc oi 41S6V leet in .ai 
honi Ol 73 }' 1(>(‘1 111 .1 iinniifo 


f I--' 1 



9 And it the ventiicle thiows out one ounce in a pulse, then in seventy- 
five pulses of a minute the quantity of blood will be equal to 4 4 pounds, 11 
ounces, and in 34 minutes a quantity equal to a middle-sized man, viz a 
hundied and fifty-eight pounds, will pass tin o’ the lieait 

10 But if Avith Di Haivey and Di Lowei we suppose two ounces of 
blood, that is, 3 276 culnek inches to be tin own out at each systole of the 
ventiicle, then the velocity of the blood in enteiing the oiifice of the aoita, 
will be double the foimei, viz at the late of 146 feet in a minute, and a 
quantity of blood equal to the weight of a man ’s body will pass in half the 
time, viz 17 minutes 

11 If we suppose, what is piobable, that the blood would use 7 plus % 
feet high in a tube fixed to the caiotide aiteij"- of a man, and that the in- 
waid aiea of the left ventricle of his heait, is equal to fifteen square 
inches, these multiplied into 7 -r % feet gives 1350 cubick inches of blood, 
which pi esses on that ventiicle, when fiist it begins to contiact, a weight 
equal to 51 5 jiounds 

12 That we may the moie leadily eompaie the above-mentioned 
seveial estimates togethei, I shall heie lange them in oidei in a table 


The several 
Animals 

Weight of 
each 

Height of 
the Blood 
in the Tube 
from Jugul 


Pd Cu 

Inches 

Man 

160 

tc 




Hoise 1st 


cJ § 

2d 


o 2 

3d 

825 

12 -S 52 

Ox 

1600 


Sheep 

91 

51 9 

Doe 



Dogs 1st 

52 

0 6 

2d 

24 

5 7 

3d 

18 

5 

4 

12 8 

4 

5 


4 6 

6 

31 


7 

43 


8 



9 


7 14 

10 

15 

5 24 

11 

37 

Si 

12 

36 


13 

24 

6 9i 

14 

37 8 


15 


5 19 

16 


54 8 

17 

19 

5 14 

18 

35 

5 

19 

32 

6 91 

20 

23 

5 7 


Height ot 
the Blood in 
Tubes fixed 
to Artenes 


Feet Inch 


8 

9 

9 


51 
2 ' 
8 
8 
8 

3 3 

it crural 
Alter 


6 

4 

6 

2 

4 


6 

6 

3 
1 

4 
6 

4 

5 


8 

6 

1 

6 

9 

7 

11 

S 


on sucking at 
on sucking 
5 2 

4 7 

3 11 

4 10 


Capacity 
of the 
left Ven 
tncle of 
the Heal t 


Cubiek 

Inches 


1 659 
3 318 


10 
12 5 
1 85 
9 

1 172 
1 

0 633 

0 5 

1 25 

1 172 

Tube fixed 


Area of 
the On 
fice of the 
Aorta 


Square 

Inches 


0 4187 


1 036 
1539 
0172 
0 476 
0 196 
0185 

Oils 
0101 
0 210 
0196 
0179 


Velocity 
of the 
Blood in 
the Aoita 


Feet Inch 
in a 
Minute 


56 55 
113 3 


86 85 
76 95 
174 5 

144 77 
130 9 
130 
120 
144 28 

156 59 


to the crural arteiy 


was very old, and died soon 


Tube fixed laterally to the left 
carotide arteiy 
the tube 


[ 146 ] 










13 I do not see, by comparing the weights of these animals, and the 
seieral quantities of blood 11111011 pass tliio’ their hearts 111 a giieii time, 
that we can thence f 01 111 aiij* iiile that is fixed, foi the piopoitioning 
the quantities of flowing blood to then diffeieiit sizes 

14 These quantities 111 laiger animals aie veiy dispioportionate to 
the bulk of then liodies, 111 coiiipai ison of ii hat they ai e 111 lesser animals 
as estimated 111 this table 

15 But as 111 the biggei animals the blood had a longei course to go, 
and must theiefoie meet with a gieatei lesistance, so we maj" obseiie 
111 this table, bj’' compaiing the peipeiidiculai heights of the blood 111 the 
tubes fixed to the aiteries, that the foice of it 111 the aiteiies is 111 the 
mam gieatest in the laigest animals 


The se\eral 
Aninnls 


How 
much 
in a 
Minute 

Weight 
of the 
Blood 
sustained 
bv the 
left 

Ventiicle 

contract 

mg 

Number 
of Pulses 
in a 
Minute 

Aiea of the 
ti ans\ eise 
Section 
of descend- 
ing Aoita 

Aiea of the 
ti ans\ Sect of 
ascending Aoitn 


Minutes 

Pounds 

Pounds 


Squai e 
j Piiches 

Squnic 

Inches 

-Man I 

14 18 

4 IS 

51 5 

75 




17 0 

0 !0 





IIoisc 3d 

00 

13 75 

113 22 

36 

0 677 

0 360 

0\ 

ss 

IS 14 


3S 

0 012 

0 85 







Right Left 

sheep 

20 

4 593 

3G 50 

05 

0 094 

0 07 0 012 






0 385 

0 246 







Right Left 

ling 1 

11 0 

4 34 

33 61 

07 

0106 

0 041 0 031 

0 

C4S 

17 



0102 

0 031 0 000 

n 

0 

7S 

2 3 

10 8 


0 07 

0 022 0 000 

4 

0 7 

1 S5 

11 1 


0 061 

0 015 0 007 






0110 

0 7 0 0 n 






0 125 

n 002 0 0 n 

7 

'10 

4 34 



0 100 

0 053 0 032 


IG And sui)])osing tiie i)lood-i essels ni tlie man and boise to lie equal)} 
dislnbuted in all Iheu homologous paits that is, if Ihov aie ])i ojioi lion- 
able to then lespeetne i\ eights then the blood must moie 111 them 
leeipiocallv as the times, in nhich quantities of blood equal to then 
lespettne i\ eights, ])ass thio then heails iiz as GO to 37 nnnutis 

17 Ho that notw ithst.inding the aiteiial blood of a hoise is jnopelled 
with ,1 gie.itei tone than that oi a man ^el it mo\es tlie slowei in the 
hoise on attount ot a gieatei mnubei of lannfuatioiis and a gieatei 
iengtli ol \essels in tlie laigei animal 

When 1 lonqiaied the inopoition that llu ana of the tiaiisMiso 
''edioiis of llu devtendnitr aotta beais to tlie Iksh .md otlu*i p.nts whuh 
th(\ stqqih A\nh (ndilaliim blood 1 lonnd it to boas lollows dr ha\nig 
dll tlu bod\ ol a dog asiindd at his luail and tiid \\di.dinig duh jiait 

f 147 ] 










separately, and then boiling them so as to separate the bottes [bones] 
from the flesh, the weight ot the bones being deducted fioin the flesh, the 
flesh, etc of the hinder part was found to weigh eleven pounds, eleven 
ounces, that of the forepart seven pounds and two ounces 

19 Now the areas of the transverse section of the arteries of these 
five animals are by measurement as follows, viz 

20 



Aorta 

desc 1 

iscend | 



In the Marel 

1 036 

0 677 1 

0 369 1 


0 412 

Os 

1539 

0 912 

0 85 

by Computation flom the 

0 556 

Sheep 

0 172 

0 094 

0 082 

iboie found pioportion of 

0 057 

Doe 

0 476 

0 383 

0 246 

flesh fiom tlie hindei and 

0 233 

1st Dog 

0 196 

0 106 

0 075 

toie parts 

0 064 

6th Dog 

0 196 

0 125 

0 093 


0 076 

7th Dog 

0 179 

0 109 

0 085 


0 066 


21 In this tabic we find that tire areas oi the transverse section of the 
descending and ascending aoi la’s ol the first dog are rieail}" irioiroitioriable 
to the weights oi the respective parts which thej" suiiplj’^ vith blood, and 
that in the mare and doe, the difleienee is not great, but greater in the ox 
and sheep In estimates oi this kind great accuracy nr the proportions is 
not to be expected 

22 The velocity with which the blood is thrown out ot the lett ventricle, 
being peiioimed in one-thiid ot the time between sys'olc and systole, the 
like quantity oi blood would move with an equable motion, ol one-thiid 
of that velocity, thro’ the orifice ol the aoilu in the space ol time betrveen 
each systole 


23 Since in a man a ejdindei oi blood oi the diametei of the orifice 
ot the aoita and 7 92 inches long, is at each pulse impelled through a 
dilatable conical artery, its velocity w'ould be greatly increased by passing 
thro’ that nai rower defile, but the arteries continually sending off in- 
numerable branches, the sum of ivhose orifices are considerably larger than 
the main stems, hence the velocity of the blood must be piopoitionably 
rebated So that as Dr James Keill, in his Tentamina Medico Physica 
p 46, has estimated it, the velocity of the blood at the heart, ivoiild be to 
Its velocity in an evanescent artery as 5233 to 1, if it had a free unem- 
barrassed course thiough those capiUaiy arteries And since the velocity 
at its passing from the heart to the aoita is at the rate of 146 feet in a 
minute, taking one-thiid of that, viz 43 2 for its continued equable velocity, 
according to Di KeiU’s estimate it ivould move but 0 00901th part of a 
foot, or 0 1128 inch in a minute, in the evanescent arteries in that time 

24 This would be its velocity theie, if the blood had as fiee and un- 
einbaiiassed a course thro’ the finer capillary arteries, as it has thro then 
larger ramifications But by the following expeiiment, it is found, that 
the^piincipal obstruction to the piogiess of the arterial blood is in the 

capillaxy aiteiies . 1^0 1 

[ 14:8 J 




EXPERIMENT IX 

1 I slit open with a pan ot seissais, fioni end to end, the guts of a dog, 
on that side which is opposite to the nisei tioii of the niesenteiic aiteries 
and veins, and haiing fixed a tube 4 + % feet high to the descending 
aojia a little belon the lieait, I ponied blood-waini natei tin o’ a funnel 
into the tube, which descended thence into the aoiia, uith a foice equal to 
that, with which the blood is tlieie impelled by the Iieait This natei 
passed off tin o’ the oiifices of innumeialile small capiUaiy vessels, which 
weie cut asunder tin o’ the nhole length ot the slit gut But notwith- 
standing It Mas impelled ivitli a foiee equal to that of the aiteiial blood 
111 a live dog, yet it did not spout out in little distinct streams, but only 
seem to ouze out at the veiy fine oiifices of the aiteiies, in the same mamiei 
as the blood does fioin the eapillaiy aiteiies of a muscle cut ti ansi ei sell 

2 Having piovided a pendulum i\hich beat seconds, and pom mg in 
tlnough the tube known quantities of w'aini wmtei, I found that 342 eubick 
niches of w^atei passed off in 400 seconds, or 6 6 minutes 

3 Then cutting all the mesenteiic aiteiies asiindei close to the guts, 
and taking away the guts, I found that a like quantity of watei passed 
tliio’ these laigei ramifications of the aiteiies in 140 seconds, oi 2 3 
minutes, that is, in one-thiid of the time 

4 Then euttnig asundei the einial ail cues, which weie befoie tied, 
and cutting off the mesenteiic and emulgent aiteiies, close to the aoita, 
a like quantity of watei passed thio' this thus cut (lo)ia in 0 308 minutes, 
that is 111 y,i 4, 01 0 467th pait of the time, in wliicli it passed lino’ the 
capillaiy aiteiies of the slit guts 

5 Theie being 342 culnck niches which passed tin o’ tlie capillaii 
aiteiies of tlie slit guts in 6 6 minutes, that is, thiiteen 2 ionnds, if it weie 
blood, 01 1 969 pound in a minute, and it being estimated in the table 
fp 147], that 4 34 pounds of blood weie tliiown out of the heait of the 
dog Numb 1 m a minute, the abo\e-menlioned 0 969^ pound is 1/2 2 = 

0 454tli pail ol what passes the heait m that time 

6 But on weighing all the fleshlv and othei inembianous paits of an- 
othei dog. thiouah whieli the aiteiial blood passes, that is, exclusne of 
the bones and lungs I found the whole weight to be eighteen ])ounds ele\en 
miiues, of which the slit gut weiffhimr one pound two ounces, was theie- 
foie, 1 16 6 Ol OOGtli pail of the whole and thcie going 4 34 pounds out 

01 the heait m a minute and 1 9G9 pounds passing the inesenteiKk aiter^ 
m the ^ame time and the slit gut weighing but 18 ounces and all the 
paits ol the bod\ weighing 299 ounces oi IS jiounds 11 ounces, tbcicfoic, 
1 969 ]iouiuls ]i.!ss lino 18 ouncis whilst 2 371 ]ionnds jiass 2‘'1 ounces 
if<u 4 44-1 ‘>69 — 2371 and 296 - lb 2^1; hut 1969 lb — 01094 


1 



and 2374/281 = 0 008474, and 0 1094 00 08474 321 91 1 ’ So that 

bulk foi bulk theie passed 12 91 times inoie watei tliiough the aiteiies ol 
these slit guts, than thiougli the lest oi the aiteiies of the body, and that 
with a foice no gieatei than that of the Jieait 

7 Which may leasonabh be attiibiited to tliese seyeial causes, as to the 
much gieatei fluidity of watei than of yiseid blood, to the moie lelaxed 
state of these aiteiies in the dead tlian iii the liying animal, foi tho' the 
aiteiies and yeins of a dead animal being then fieed horn the distending 
foiee oi the blood do eontiact, j^et with equal foices, those of the dead 
animal will dilate moic than those of a liye animal but this moie plentiful 
flow of watei is piincipally owing to the gieat diffeience there is in size, 
between these cut capillaiy aiteiies, and the succeeding senes ’s of exceed- 
ing small lamifications, and that at light angles, thio’ which the blood 
passes in its fuithei pi ogress towaids the yeiii as also to a want of the 
lesistanee of the venal blood, which using six niches m the tube fixed to 
the jugulai yein is 1/13 33 oi 0 075tli pait of tlie foiee of the aiteiial blood, 
and must theiefoie piopoitioiiablj letaid its motion 

8 The diameteis ot tlie cut oiifices ot the aiteiies thio’ nhicli the 
watei passed off, weie at a medium, one A\ith anotliei, equal to twice the 
diametei of a haii , winch Di Juim, In an aecuiate estimation, found to 
be l/324tli pait ot an inch, hence these aiteiies, which aie 1/162 inch 
diametei, as they bianeh off fiom the meseiiteiicks, spiead themselves 
alternately on each side ol the guts, whence meeting again, then inosculat- 
ing blanches foim ai cola’s like those that aie on the leaves of tiees and 
from these thus eonveiging aiteiies and sap-vessels, theie blanch off neaily 
at light angles, without coineigiiig any moie, much smaller aiteiies, and 
fiom tliese otheis again, both at light angles, and like the spiead fingeis of 
a hand, in successive senes ’s in then piogiess towaids the veins 

9 The diameteis of the fiist senes ’s of these iiiiconveignig blanches, 
may in a piece of gut well injected with veimihon, be obseived to be of 
several sizes, fiom % to 34 of the aiteiies whence they lose, and the suc- 
ceeding ones finei and finei to neaily l/3240th pait of an inch, that is so 
fine, that only single blood globules can pass them into the veins, lieie tliere- 
foie, so viscid a fluid as the blood must needs meet with a veiy gieat lesist- 


ance 

10 These reticulai eonveiging aiteiies, by being thus moseiilated into 
each othei, both pi event obsti uetions in them, and also theieby the most 
plentiful supply the next senes of lectangiilai blanches with blood, foi 
if the blood had enteied the eonveiging aiteiies only at one end, its velocity 
would theieby have been moie letaided in going the whole length, than 
half the length of these eonveiging aiteiies, by these iiinumeiable con- 
veigencies of the aiteiies, the blood is moie blended and mixed, as is plain 
to be seen in the lungs of fiogs 


t 1- or*! nfQ n r in this nroportion wliicli wg rGpimt Gxs.ctlj’* cis it 

♦Several obvious er ors \ 12 91 is obtained as follows 1 969/18 = 0 1094 

= 0'00mrand"^0^^ O 0 V 474 12 91 1-F A wr 1940 

[ 150 ] 



11 Fioni this expel iment iie see lioiv gieatly the velocitv of the yatei 
IS letarded in passing thro’ the seveial blanchings of the aiteiies, notwith- 
standing the sum of the aieas of their tiansveise section is considerably 
greater than that of the aoita And this letaidation must be still gieatei 
to the blood which is both a giosser and nioie iiscid fluid than water, and 
that especially in the extieme capillary aiteiies winch blanch off at iiglit 
angles, and winch are about l/1620th pait of an incli in diameter so fine 
that only single globules of blood can pass them 

12 And to this lesistance nliich the blood meets with in passing the 
capillaiy arteiies, is oniiig the gieat diffeience of the foice of the blood 
in the arteiies to that in the veins, viz as 10 oi 12 to 1 

13 Poi tho’ the velocitv of the blood at its fiist entiance into the aoiia, 
depends on the inopoition the aiea of its oiifice beais to the quantitv 
thiomi into it at each systole, and also on the numbei of those systoles in a 
given time yet the leal foiee of the blood in the aiteiies, depends on the 
piopoition, which the quantity of blood tliiwii out of the left lentiicle, 
in a given time, beais to the quantity which can pass tin o’ the capillaii 
aiteiies into the ■veins, in that time 

14 But the lesistaiiee which the blood meets vith in those capillaiy 
passages may be gieatly yaiied, either by tlie diffeient degiees of the 
yiseidity or fluidity of the blood, oi bv the several degiees of const net ion 
or lelaxation of those fine vessels, instances of which may be seen in 
Expel imcnts 15, 16, 17, 18 

15 And as the state of the blood oi blood-yessels is in these respects 
continually yaiynig fiom diyeis causes, as motion, lest, food evacua- 
tions, heat, cold, &c so as piobabh' nevei to be exactly the same any two 
minutes, dunng tlie whole life of an animal, so natuie has wiselv' pio- 
yidcd, that a eoiisideiable vaiiation in these, shall not gieatly distiub 
the healthy state of the animal 

16 IVe may make a pietty neai estimate of the foice of the blood in 
the capillaiy vessels in the following maniiei , viz taking the diametei 
of a blood-globule to be as above l/3240th pait of an inch, which Leewen- 
hoeck has ohseived to be of the same si/c both in small and gieat animals, 
and allowing those capillaiv' vessels to be a small si/c laigoi than tho 
globules, which swim iii and aie earned along bv' the scnivi whuh sui- 
lounds them on all sides, we mav theiefoie well suppose one of these vessels 
to be double the diametei of such a globule iiz 3/lG20th ]iait of an inch, 
01 0000617, tho jieiipheiv theiefoie oi this vessel will he 0 001030 and its 
aie.i 0 000000208 which multiplied bv $0 the iiuinbei of inches to whieh 
the blood lose in the tube when fixed to the aiteiv of the dog Xunih 1 
gives OOOOJoO ]i.uls oi eightv cubuk inches of blood, oi of 21 416 giains. 
ecju.il to 0 .)! ) ]iails oi ,i gi.nn But the' icsisi.mce of the* blood in the V( ms 
oi the same dog being tcuind etjual to six inchc's height oi 1 13 33d oi 
0075 ]>aits of eightv inches this 1 3133d p<ut = 003039 Ijciiig deducted 

1 mi 3 



out of 0 5118 parts of a giam, the lemainder 0 4734 gram is the foiee with 
which the blood would be impelled into such a capillaiy by a column of 
blood of eighty inches height, supposing it weie in a stagnant state, to 
Avhieh also must be added the velocity which the blood has aequiied at its 
fiist entiance in the capillaiy vessel, which can be but small, as appeals by 
the gieat resistance it meets with in the capillaiy vessels, in this 9th Ex- 
pel imeiit, Numb IS, whence we see, both fiom expeiiment and calculation, 
that the foice of the blood in these fine cainllai les can be but veiy little, 
and the longei such eapillaiies aie, the slowei will the motion of the 
blood be m them 

17 It is obseivable, that these paiallel aiteiies aie not as in the 
bowels, lungs, and othei membianous paits of the body, inteimixed with 
eon esponding similai veins, but two diffeient senes ’s of these aiteiies, 
aiising at light angles fiom laigei aiteiies, one senes fiom the uppei, 
and the othei fiom the lowei paits of the muscles, then paiallel aitenes 
do mutually and alternately inteimix, wheieby the blood is conveyed 
in them altei natelj’’ upwaids and downwaids, and thence flows at light 
angles into the veins 

18 Fiom this veiy small foice of the aitenal blood among the 
museulai flbies we may with good leason conclude, how shoit this foice 
IS of pioducmg so gieat an eftect, as that of museulai motion, which 
wondeiful and hitheito inexplicable inysteiy of natuie, must theiefoie 
be owing to some moie vigoious and active eneigj’', whose foice is legu- 
lated by the neives but whetliei it be confined m canals within the 
nerves, oi acts along then sui faces like eleetiieal poweis, is not easy to 
detei mine 

19 That a vibiating electiical viitue can be conveyed and fieely act 
with consideiable eneigy along the suifaee of animal fibies, and theie- 
fore on the neives, is evident fiom cuiious expeinnents, made by that 
skillful and indefatigable expeiimentei. Mi Stephen Giay, of which 
he has given an account in the Philosophical Ti ansactions, Numb 417, 
422, wheie he shews that electiical vntues fiom a glass heated by nibbing, 
will not only be conveyed along the suiface of lines to veiy gieat lengths, 
but will also be fieely conveyed fiom the foot to the extended hand of a 
human body suspended by lopes in a hoiizontal postuie in the an , and 
also fiom that hand to a long fishing-iod held in it, and thence to a stiing 
and a ball suspended by it and also that an electiical viitue may be earned 
along a suiface of watei 

20 And It has been fiequently obseived, that when some pait of the 
body has upon itching been gently scratched by the nails, theie has at 
the same time been felt in a distant pait, a veiy pungent stimuhis oi sensa- 
tion answeiing exactly stioke foi stioke to the action of the sciatching 
nails Thus particularly, on sciatching a small pimple, a little below the 
light loiee on the outside, a like pungent sensation has been felt on the left 

[ 152 ] 



shoulder-blade, and sometimes on that aim some inches beloir the shouldei 
and vice veisa the light shoulder or aim has m like mannei been affected, 
when the sciatching has been made neai the left laiee, but this effect does 
not always follow theie aie many instances of the s-^mipathy of the neives 

21 That the animal spirits, whethei they act ivithiii oi on the outsides 
of the neives, aie elastick, seems piobable not oiilj' fioni then gieat activitv 
and eneigy, but also fiom the sudden and stiong effects that sulphuieous 
vapours, which are known to destio}’’ elasticity, aie found by expeiienee 
to have on them Thus the fumes of buining biimstone will instantly 
depiive all animals nhatevei of life thus also the subtile and most peiie- 
tiating fumes of feimenting spiiituous liquois, aie knomi either to stiike 
those instantly dead vho smell to them, or to infatuate or lender paialytic 
for life, those who smell to them in lessei degi ecs Thus also the sulphui eons 
foetid fumes of buiiit featheis, etc have an effect on the disoi deied spirits 
of those who aie in fits Thus also assa fochda, casfoi , which abound 
with a subtile sulphui, aie found to be fiiendlj^ to the spirits of the 
hysteric, as on the eontiaij’- aie many fumes most offensive to the spirits 
of otheis 

22 If the skin be flead off the bellj’- of a live fiog, and the abdomen 
opened on each side, so as that its stiait muscles may, by di awing a 
little on one side, have a stiong focal light cast on the inside of them, 
if in this postiue those muscles be viewed tin o’ a good micioseope, the 
paiallcl fibies of the muscles aie plain to be seen, with the blood lunning 
alteinatcly up and down betneen each fibie, in capillaiy aiteiies so fine 
that only a single globule can pass them If tlie muscle happens to act 
while thus viened, then the scene is instantly changed fiom paiallcl 
hbics, to senes ’s of ihomhoidaJ j^^vnvhic nliieh imiiiediatcly disappeai 
as soon as the muscle ceases to act It is not easv to get a sight of this 
most agiccalile scene, liecause that on the action of the muscle, the obiect 
IS apt to get out of the focus of the micioseope, but those nho aie cxpcit 
in the use of those glasses may leadilv nio\e them accoidingly I have 
found small fiogs best foi this puipose, viz such as aie not aboie Yi oi Yi 
of then full gionth Stimulating the foot of a fiog, mil sometimes make it 
eontiacl these muscles The fiog must be fixed in a piopei fianie If ic- 
pcated obsonations neie made on the muscles thus ni action, it might pei 
haps guc some faithei insight into the natuie of musculai motion 


n' 1 



time, into this laige field of statical and othei expeiiments, whence we 
see what gieat eneouiagement we have to spin us on in these pursuits, 
since the wondeiful works of the gieat Author of nature aie so fruitful 
in fuinishing us, fioin its inexhaustible fund, with fiesh mattei for oui re- 
seaiehes, and thence witli the inexpiessible delight, of new and farther 
motives to adoic and piaise oui all-gloiious Makei in his woiks 

EXPERIMENT XP 

1 As to the foice ivitli whicli the blood is impelled fiom the right 
ventiicle of the heait into the pulmonaiy aiteiy, it seems impracticable 
to attempt the finding of it, by fixing a tube to that aiteiy, in the same 
maiinei as to the carotid and ciuial aiteiies of living animals, because the 
animal must needs die while it is doing 

2 The aiea of the tiansveise section of the pulnionaiy aiteiy being 
in one pait, befoie it divai mates into bianelies, of tlie same dimension with 
tlie oiifice ot the aoita, tlic velocity of the blood in that pait may be ac- 
counted tJie same as in the oi ifiee ot the ao? to But tlio ’ the quantities and 
yelocities of the blood, in jiassing out of both ventiicles, be the same, yet 
it does not thence follow, that then expulsive foiees must be both the same 
foi if the blood in passing into the pulmonaiy aitery, finds less lesistance 
from the pieceding blood, than the blood does in enteiing into the aoita, 
then a less foice will expel it out of the light %entiicle with equal velocity, 
and accoidingly, as theie is not so much foice lequiied to diive the blood 
tliio’ the lungs, as tliio’ the lest of the whole body, so we may obseiye, 
that the substance of the muscle of the light ventiicle has not neai the 
thickness of that of the left The following expeiiments and obseivations 
may give us some light into this mattei, I’tz 

3 I fixed a glass tube to the pulmoiiai}^ aiteiy of a calf’s lungs, and 
then thio’ a tunnelt pouied waim watei into it, then with a large pan 
of bellows fixed to the wind-pipe, I alternately dilated the lungs, to tiy 
if by that means the watei would pass into the pulnionaiy vein but I 
soon found myself disappointed, foi the watei flowed so fieely fiom 
the eapillaiy aiteiies tin o’ the tunicles of the vesicles, into the vesicles 
themselves, and thence into the hionchtae, as to flow plentifully thio’ the 
wind-pipe, when it hung down in a depending posture At fiist I suspected 
that the foice of the watei, which was foui feet high, in the tube affixed 
to the artel y, might have buist the thin blood-vessels, but I found it the 
same in seveial trials, on the fiesh waim lungs of sheep, oxen, and calves, 
even when the pei pendiculai height of the watei of the tube was less than a 
foot , and doubtless the foi ce ivith which the blood is tin own into the lungs 
by the light ventiicle of the heait, is gieatei than this 

4 And that so small a foice of watei could not buist the blood-vessels, I 
was assured by the following experiment, v%z I dissolved 4 ounces of nitie 

^ei.ment X has been omitted fiom the present printing -F A W 1940 

fFunnel — F A XV , 1940 r 1*54 1 



in a pint of liot watei, into ■\\liicli A^atci tlieie floned fiom the cut tin oat 
of a ealf, a quait and a quaitei of a pint of blood, ^^]lleh ^^as kept in a 
diluted state by the nitiated natei Haiing then fixed a tube ^ihich nas 
2 feet long, to the pulmonaiv aiteii of the aboi e-mentioned calf s lungs, 
I poured gradually into tlie tube, of the nitiated blood, as inucli as the 
arteiy and its lamifications nould eontain, nliich nas neai a quait, none 
passing, that I could peieeive, into the pulmonai.y vein The lungs neio 
much dilated, and looked \eiy led but notwithstanding the peipendieulai 
height of the blood in the tube ivas 2 feet, yet no blood passed thiough 
the tunicles of the vesicles, into the vesicles and hionclnae, foi when tlie 
wind-pipe w'as held downnvaids, nothing flowed out but a white fioth, a 
plain pi oof tliat wdien the watei was less tlian a foot peipendieulai in 
height, in the foiegoing expel imcnts, it did not foieiblv bieak thiough tlie 
blood-vessels, but must pass thiough poies wdiich weie too fine foi the 
globules of nitrated lilood to pass those poies being peihaps something 
laigei in the lungs of a dead animal, tlian when alive, foi upon death all 
the fibies of the body aic lelaxed When I cut a slasli into the substance 
of the lungs, tlie nitiated blood fieely flowed out 

5 And that the capillaiv aiteiies w'eie not buist In the foicc of the 
w’atei, seems faithei piobable fiom hence, viz I fixed a tube 5 feet long to 
Die pulmonaii leni of a hog’s lung’s and ponied in waim watei, wliicli 
neitliei flowed into tlie pulmonan aiteues, noi among tlie hiontlnae, an 
aigunient that this foice did not buist the lenis, which some anatomists sai, 
Ua\ c no val\ es in them 

G When I fixed the same tube to the wind-pipc of those lungs, and 
ponied in w'atei, it jiassed thiough the hionclnae, and laii out of the onfice 
of (he pulmonaiN aitei^, but not abo\e one-fifth so fast, as when its com so 
was the ie\eise, viz iioni the jiulmonai v aitci\ to the hi onclnac, in which 
case It lun at the late of a pint in a minute Yet when an was blown into 
the caMli of the lungs, thio’ the wind-])i])e, none passed thence, citliei 
into the pulmonaiv aiteiy oi lein 

I Anothei time I tiied also whcthci the tliui souim of a hog s blood 
would pass liom the puhnonaiv aiteiies, tliio the coiiesponding icnis 
of the lungs, oi the same hog, which lungs weie kept w.um in watei , the 
seiiim passed most fieclv tluo into tlie hi onclnac, hut not into the leins 


t i*.s ] 




1749 

JEAN-BAPTISTE DE SENAC 

TREATMENT OF “REBELLIOUS PALPITATION” 

WITH QUININE 




JEAN-BAPTISTE DE SENAC 

(1693 1770) 

“Thcoiy reduced io consequences draiun from facts alone, rs the light of giactice 

— Sen ic, m preface to Xe Traite de la Stiuctinc du Cccui 
(1749), quoted b^ Renouard 

^EAN-BAPTISTE DE SfiNAC was born in 1693 in the district of Lombez in 
y Gascony, France From his birth to the date of publication of his first work in 
1724 nothing definite about him is known, but it is said that at fiist, encouraged 
by his parents, he decided to study for the ministry Later he changed his studies to 
medicine 

There is no definite knowledge as to where or when S§nac studied medicine 
Degris wrote that Eloy, in his “Biographical Dictionary,” said that S6nac received 
his Bachelor’s degree from the Faculty de Pans but Degris thought that this was 
an error, since Hahn could not find S6nac’s name in the “Commentaries of the 
Faculty” or in Baron’s list of recipients of the Bachelor’s or Doctor’s degree of the 
Faculty 

S6nac, it is known, accepted the appointment of consulting physician to the King 
in 1738 and on his first publication he signed himself as a member of the faculty of 
the University of Montpellier, which Nod Legrand called the oldest university in 
Europe 

According to Degris, it is believed that Sdnac came to Pans when he was about 
thirty years of age In Pans he published his first work in 1724, a translation of 
Holster’s “Anatomy ”i In 1724 and 1725 he communicated before the Royal 
Academy of Sciences two memoirs “On the Organs of Respiration” and “On 
Drowning ’ ’ In 1724 he became an associate member of this academy 

In 1727 he published an appreciative account showing the different methods of 
the llthotonusts entitled “Discours sur la mdthode de France ct sur celle de Ran 
Touchant I’Opdration de la Taille ” Sdnac published many more interesting con- 
tributions, but none is as famous as his “Traitd de la Structure du Coeur” (1749), 
which we shall later discuss in more detail 

Sdnac mo\cd to Versailles in 1733 where he became physician to the Rojal House 
of Saint-CjT and to the Royal Hospital of Versailles 

In 1745, Sdnac cured the great French general, Maurice, Count de Saxe (1693- 
1750), of a serious disease and later accompanied him on his campaigns In 1751, 
after the death of hlaunce, who was given Tiircnnc’s title of “hlarshal general of 
the King’s armies and camps,” S6nac became chief pha’sician to the Duke of Orleans 
and in 1752, after the death of Chicojuicau, he became chief ph\Eician to Louis XV 
He treated the dauphin during his illness from smallpox in 1752, and again dunng 
the young man’s fatal illness from tuberculosis in 1765 In addition to the members 
of the court ho numbered among his patients Madame do Pompadour 


i IV j 



In 1760 and again in 1761, Voltaire addressed two letters to S6nac The first 
supported S^nac’s memoir on a certain contagious disease which had devastated the 
country around Perney, and the second was a missive of thanks to the “chief 
physician’’ for his good work in aiding some people who lived close to a con- 
taminated marsh 

Louis XV appointed S6nac counsellor of state and superintendent of the mineral 
waters and medicinals of the kingdom 

Sdnac died on December 20, 1770, at the age of seventy-seven years He was 
survived hy two sons, one of whom, Gabriel S6nac de Meilhon (1736-1803), was a 
writer and was invited to Eussia in 1792 by the Empress Catherine II, and the 
other of whom was a superintendent of agricultural revenues 

SSnac’s fame in cardiology rests, of course, on his important work first published 
in 1749 in two volumes, “Trait4 de la Structure dii Coeur, de son Action et de ses 
Maladies ’ ’ A second edition of this valuable work appeared in 1777, seven years 
after the author’s death 

In his original work, which greatly surpassed studies of the heart made by his 
predecessors, S6nac made many noteworthy observations Among these are his 
descriptions in detail of the structure of the heart and the direction in placement of 
its fibers He discussed the transfusion of blood He noted the increase in incidence 
of cardiac disease with the increase m age and considered dilatation to be the most 
common of all cardiac conditions S6nac related pericarditis to inflammation of the 
lungs and mediastinum He acknowledged that hydrothorax played a conspicuous 
part in failure of circulation He was the first physician to use guinme for palpita- 
tion, and it IS this classic description which we are republishing herem in translation 
Accordmg to Long, the germ of the modern idea of septicemia is seen m SSnac’s 
conception of the condition as caused by pus which flowed back into the blood from 
the loci of external ulcers 

S6nac regarded with skepticism the remarks of early writers on “hairy” hearts, 
and on stones and worms in the heart He believed that polyp of the heart was a 
formation occurring at the time of death Senac entertained a curious idea about 
the remote cause of movements of the heart He thought these motions were trans- 
mitted by an animal spirit situated in the brain and spinal marrow He thought of 
this spirit as an extremely elastic fluid, which the impression of the blood on the 
delicate tissue of the panetes of the heart and the columns of the ventricles put 
into action 


[ 160 ] 



TRAIT E 

LA STRUCTURE 

DU C(EUR, 

DE SON ACTION, 

ET 

DE SES MALADIES 

Par M S E N A C , Mcdccm Confultant du Roy 

^f.iltum cy:ruvt q'li <mic ms f icruut , nt dtum cti tm iiSiuc rcjhtt opens, 
}} dtu > ^ le icp 'bit > lice dit lutto pofi i>t lie peci f i pttfclutlcsur 
occafo idtquii t'dpcienis Ann Seneca 

TOME PREMIER. 



A PARIS, 

Chez JACQ.UES VINCENT , rue &: vjs- a VIS I’Eglifc 
dc S Sc^ enn , a 1 Angc 


M DCC XLIX 

ArrKOJiATlON LT PRIFILEGL JDU ROr 



OPERATION OF STOMACHIC REMEDIES 
IN PALPITATION* 


[Including the use of quinine m rebellious pTlpitations] 


T liE above are not the sole lesouices of Medicine against palpitation, 
aid has been found in vaiious lemedies of which the piopeities aie 
veiy diffeient These leinedies aie the stomachics, the cordials and 
the sedatives The stomachic lemedies have appeared to varrous physrcrans 
as a resource agaiirst palpitations, for it is often in the stomach that then 
cause resides, if they do not arise from this as an immediate cause, there is 
in many eases an occasional cause which sets the other in motion The 
ancients, attentive to sensilile effects, have accused flatulence risanus, 
Higmei and Bartholin have had the same idea It is true that if the first 
instrument of digestion is inflated by the action of the an that it contains, 
it will produce the same effects as if it were full of aliment, and when it 
cannot empty itself it will agitate its viscera and its nerves and may ev- 
cite palpitation, as Widelius has judiciously lemaiked The majority, he 
says, of those who are subject to palpitations are liypoclwndnacs, the func- 
tions of then stomachs are deranged, and this derangement troubles the 
action of the heart 


The derangements of the viscera are thus an object that one must not 
lose sight of in the treatment of palpitations, it excites them often when 
it IS overloaded, thus regularity is one of the necessary conditions to avoid 
the agitation of the heart or to calm it If it comes fiom a vice of that 
organ, sobiiety is not less essential, excess adds to this vice a new irrita- 
tion, the visceia of the lower abdomen being o\ei loaded, are too much 
pressed on by the mass of the full stomach, and these push the blood with 
more force and give stimuli to the nerves which may tiouble the movements 
of the heart 

When patients are put on a regime one must facilitate digestion if this 
IS possible, such a resource will be the moie necessary if the palpitations 
are excited by the viscera, or if they are occasioned by the derangement of 
its functions, when one must first of all attempt to prevent food from 
staying too long in the stomach, and see that food of pool quality be not 
taken 

Bittei extracts and other similar lemedies aid the stomach to empty 
itself, they act on the membranes to stimulate and urge them, they have 


*t?4nac J B Traite de la stiuctwe dti coeur, de son action et de ses maladies, Pans, 
Chez Jacques Vincent 1749, Tome Second, xrnil P 524 Translated bj Maurice N 
Walsh, M D , Majo Clinic [ 162 ] 



some of the qualities of the bile, 'tthich thej’ leplaee Ailieii it does not flo'w 
easily oi has lost its qualities, but then opeialion eaiiies ^Mth it some dis- 
ad^antages, thev aie a\ aiming and thus it is iiecessaiv to avoid oi to mod- 
erate then usage in bodies vhich aie too sensitnc and susceptible lo im- 
piessions of heat The usage of caiminatnes necessitates the same manage- 
ment, these aie not lemedies that one can neglect as thev ha\e pioduced 
happy results accoiding to 'Widelius and othci phvsicians 

If aliments dcgeneiate in the stomach the bad qualities that the\ pio- 
duce lediiee to tvo thev become acid oi lancid It is to absoib the bittci 
and to collect lancid oils that plnsiciaiis lune lesoiiice to eaitln ab- 
soibents as leniedies that mav calm palpitations The efficacv ot these 
lemedies is lecognized bv all obseneis in the maladv called Soda, that is 
to say in that deiangement of the stomach which sends into the esophagus 
a buimng heat, oi a kind of caustic hquoi which appeals to lca\e impios- 
sions of file in its passage 

In geneial, lemedies winch facilitate digestion ha\e been legaidcd as 
lemedies loi palpitation of the heait Widelius has pieseiibed the elixii 
de piopiiete (simple cIimi *?) , Maieatus leeommends Rhapontie as a pio\en 
lemedv, he gnes an infusion of it in wine with Panax, lound AiistolOv'>lius, 
Gieek Pennel Ruieie has gnen his appio\al to this leincdv which in 
tiutli acts at the same time as a puigatne and appiopnate to Insfenral 
affections 

Of all ihc domaclnc jcmcdus ihe one whose cftecis have appealed to 
me the most constant and the most pionipt in nianij eases, Quinine mi ted 
with a little ihnhaih Lone/ and ichelhou}> palpitations have ceded to this 
fchiifueje, seconded with a lie/ht puigativc 

One must place among the stomachic lemedies the coi dials which ha\e 
been icgaided as cfleclnc lemedies against ]>.ilpitation 


! 1 ' 1 




1755 

ALBRECHT VON HALLER 

DESCRIPTION OF CALCIFICATION OF THE 
HEART AND PERICARDIUM 




33 •Der Orasse halier 

\ n I n«Jcflticri.«t 


WFESE4 Ofc DJWnh^* nibrf<b» 


ALBRECHT VON HALLER 
Portrait by Sigmund Preudenberger 


(Courtesy Chailes C Thomas ) 


ALBRECHT VON HALLER 

(1708-1777) 

“The Fnnce of Physiologists ” 

— Pettigrew 

(^LEEECHT VON HALLER was bom in October, 1708, at Bern, Switzerland 
His father was a prominent lawyer and Albrecht was his fourth and youngest 
son Young Haller showed a large capacity for knowledge in early childhood At 
the age of four he expounded the Scriptures to the servants, at eight years of age, 
he had wntten 2,000 brief biographies, and by the time he was ten years old he had 
written a brief lexicon of Greek, Hebrew, and Chaldean 

Haller continued to astound his family with his intellectual achievements, for 
at the age of twelve he began to write verse When he was either fourteen or 
fifteen, we are told, he wrote an epic poem of 4,000 stanzas on the “Origin of the 
Swiss "Union of States ’ ’ At this time he also translated Ovid, Horace, and Virgil 
In 1723 Haller niatnculated at the University of Tubingen Two years later he 
traveled to Holland, where he studied under the renowned Boerhaavc He later 
wrote a commentary on the works of his great teacher At the age of eighteen, 
Haller received his medical degree from the University of Leyden In his disserta- 
tion he disproved Coschwitz’ supposed discovery of a new salivary duct Haller 
proved this anatomic stnicture to be a blood vessel 

After receiving his degree, Haller traveled to Prance and England where he 
studied for a time before returning to Switzerland Then he went to his native 
country, studied mathematics under Bernouilli in Basel and later returned to Bern 
to practice medieme In 1734, vhen the Republic of Bern established an amphi- 
theater, Haller v as invited to give demonstrations in anatomy 

With the founding of the University of Gottingen in 173G, Haller was asked bj 
George II, King of England, who was also Elector of Hanover and Bninsvick, to 
fill the chair of anatomy, surgery, and botany Haller accepted and remained in 
Gbltingcn for seventeen jears At Gottingen he founded the Anatomical Museum 
and Laboratorj’, the Botanical School and Garden and the Department of Obstetnes 
He also founded there a journal entitled “Gottinger gclehrtcn Anzclger,” to 
vhich he contributed more than 12,000 book reviews During this tunc, also, he 
received attracts c offers from Oxford, Lejden, and Berlin, but refused them all In 
1752 the Emperor Joseph conferred a baronctev on H.allcr This he did not accept 
Haller returned to Bern in 1753, where he remained until his death in 1777 In 
his last da\s he *:uffcrcd from an inflamniatorv condition of the bladder «o painful 
that he could be reliei cd onl\ b\ large do'os of opium 

The most productive period of Haller s litcran, career began in Gottingen He 
vas perhaps, the mo^t prodigious and acr^atile writer of all times Acco'-ding to 
Garri'^on, while Haller was m Gbttingen he wro^e soi"e 13 000 *cirntific papers V,e 
ha\c Jicntioned his 12 000 hook remews comnbu’ed to the journal he had foarded 
■\t Glittiugen also, Haller began his classic expenments on nerve sens>b'li*% 



muscular irritability which were to he published in 1767 And at Gottingen he laid 
the foundation for his huge and most authoritative work in physiology, “Elementa 
Physiologiae corpons humani ’ ’ This was published in nine volumes at Lausanne 
from 1759 to 1769 

It IS impossible in this brief account even to mention all of Haller’s contnbu- 
tions to medicine As far as we know, he was the first to describe calcification of 
the pericardium This description we are mcludmg herein 

Before Haller published his great work on physiology, he contributed several 
monographs on physiology and its relationship to embryology, circulation, reproduc- 
tion, formation of bone and irritability 

According to Hemmeter, the principal contributions of Haller to anatomy were 
(1) a demonstration that the so called salivary duct was a vein, (2) an investigation 
of the respiratory muscles and an exhaustive description of the diaphragm, with an 
interpretation of the intercostal muscles as elevators of the ribs, (3) a demonstration 
of the uterme musculature, (4) a demonstration of the com vasculosi, (5) a correct 
description of the musculature of the heart and an accurate description of the peri- 
cardium and the valves in the veins, (6) a description of a number of hitherto un- 
known arteries, (7) recognition of the higher situation of the bladder above the 
pubes in children, (8) description of the omentum and (9) demonstration of the tela 
cellulosa as a connective tissue substance 

To cardiac physiology Haller made many contributions He stressed the changes 
of the heart occurrmg during contraction and he was familiar with the influence 
of gravity and respiratory aspiration of the thorax on the circulation of the veins 
He also succeeded in demonstrating the automatism of the heart 

Haller gained universal admiration for his several works on botamcal subjects 
and in his “Histona stirpium indigenarum Helvetiae” he descnbed 2486 species of 
plants He holds an important place in the history of German literature, his poetry 
having been regarded as outstanding His well-known poem, “The Alps,” was pub 
lished in English in 1729 Twenty-two editions of it were published in German and 
it was also translated into French, Italian, and Latin He also contributed to history 
his splendid biography, “Life of Alfred the Great ” 

By all means, mention should be made of his numerous bibliographic undertakings 
Haller had made it a custom to write a concise summary of the books he read His 
“Bibliothecae,” composing his bibliographies on anatomy, hotany, surgery, and 
medicme, compiled from his lifetime of reading, include 52,000 works* According to 
Fulton, next to the “Index Catalogue of the Surgeon General’s Office” of the 
United States Army, this collection represents the greatest compilation of medical 
titles ever assembled Not only is it an index to the world’s medical literature up 
to and including Haller’s era, it is also a compendium in which each author’s 
biographic data are given, a summary of the work is presented, critical comments on 
the author’s views are offered, and other considerations that Haller thought of in- 
terest are included 

Haller was married three times His first two wives died and by his third wife 
he had eleven children Of these, four sons and four daughters survived him Among 
the few honors that he chose to accept were membership in the Academy of Sciences 
of Pans and fellowship m the Eoyal Society of London Gustavus III, Kmg of 
Sweden, also made him a knight of the Polar Star 


[ 168 ] 



ALBERTI 

H A L L E R I 

VR^SIDIS S. REG. SC GOTTING. 

OPUSCULA PATHOLOGICA 

Partim recufa pmtlm inedita * 
au I B U S 

SECTIONES CADAVERUM 

MORBOSORUM 

Totiffimum contmentm . 
ACCEDUNT EXPERIMENTA 

DE RESPIRATION E, 

QJJARTA FARTL AUCTA, 



LAUSANNE, 

Sumpt I\Iarci-I\I ich. Bousq.uet & Soc. 


M D C C L V. 



DESCRIPTION OF CALCIFICATION OF THE HEART *'• 


But the following unusual disease is woitliy to be lemembeied, fiom 
it a most admiiable young peison died not long since The mothei 
of the boy I peieeived on medical examination eight yeais pieviously to 
be subject to iialpitation of the lieait, the youth now fell into the same 
illness He himself, on the day of his death, was without the pulse which 
you feel in the wiist, howevei I found the eaiotids to be violentlj^ thi eb- 
bing [The patient] chilling, then dienched ^\lth sweat, I leluctantly gave 
a bad piognosis 

Shoitly aftei death we opened the body The peiieaidium of the lieait 
and the pleuia of the lungs weie eveiywheie attached, and all o\ei the 
suiface of the peiieaidium vcie white liaid masses, some fiim and some 
filled with white mateiial like pus These haid swellings weie totally 
and indissolublj’’ united to the peiieaidium bj’’ bands The semi-stone- 
like infeiioi pait of the light A’-entiicle was stiongly adheient to the 
peiieaidium by a mass of tophaceous calculi like fine sand The sinus 
between the two membianes of the aoitie valves was hard and in pait 
stony In the aoitic valves between the membianes theie was a stiange 
mateiial, in fact the tendons which held back these valves weie even 
found to be fleshj’-, and with vaiiable bony scales 

But a special disoidei was concealed in the valves of the puhnonaiy 
vein These weie all excessively haid and solid, tliey weie completely 
filled with stony mateiial, to the extent that the fibies giated whenevei 
they weie cut Even the tissue of the puhnonaiy sinus was foinied of 
stony mateiial Neithei the heait noi the gieat vessels exceeded the 
usual size 

The patient’s age, twenty yeais, inci eases the laiity of the disease 
The heait of this youth was not stopped up, neithei was it satisfactoiilv 
open, it lacked alternate lest, without which no heait can live Now 
the left ventiiele leceived blood with gieat difficulty fioni its sinus and 
by its contraction sent it through the iigid opening of the osseous mitial 
valves to its sinus Thus fiom the aoita in like mannei the blood could 
return between the inexplicably iigid aoitic valves into the heait 
Whence, with the heait peipetually stimulated, it palpitated unmtei- 
luptedly, and since it could not send enough blood to the hi am, in this 
manner a stupoi was produced, like that which befalls with loss of blood 
from venesection oi fiom wounds 

•Von Haller Albrecht Opuscula Pathologica, Lausannae Bousquet et soc , 1755, p 
135 Tianslated bj Mauiice N Walsh MD Ma^o Clinic 

[ 170 ] 



1761 

JOHN BAPTIST MORGAGNI 

DESCRIPTIONS OF MITRAL STENOSIS, HEART BLOCK, 
CALCAREOUS STENOSIS OF THE AORTIC VALVE 
WITH REGURGITATION, CORONARY SCLEROSIS, 
AND ANEURYSM OF THE AORTA 







JOHN BAPTIST MORGAGNI 

(1682-1771) 

“Those who haic dissected or inspected many (Vodics), haic at least teamed 
to doitht , when others, who arc ignorant of anatomy and do not talc the tiouhtc to 
attend to it, arc in no doubt at alt ’’ 

— ^lorgigni, letter 1C, article 25, of Dc scdibus ct 
caiisis morbornm, after Adams 

CTTIy/'ORGAGNI was liom on Feliruary 25 near Bologna at Porli, at that tunc an 
C/ K 6 unportant Italian town He matriculated at the University of Bologna, 
where he studied under the faculties of philosophy and medicine He was graduated 
from Bologna in 1701, with high honors from both faculties 

Soon after graduation Morgagni accepted at Bologna the position of prosector 
in anatomy under the famous teacher, Antonio Mana Valsalva, a pupil of Malpighi 
Morgagni assisted Valsalva in the preparation of the latter’s famous work on the 
anatomy and diseases of the ear i This work was published in 1704 

Morgagni esteemed Valsalva and later edited the anatomic writings of his former 
teacher Morgagni’s editing of Valsalva’s work was supplemented by some of his 
own observations, and he later added a memoir to the life of Valsalva (1740) 

When Valsalva resigned his position to accept an offer at Parma, Morgagni suc- 
ceeded him at Bologna as demonstrator in anatomy In 1706 Morgagni became 
president of the Academia Inquiotorum of Bologna At this tmic he published in six 
parts his first notable work, “Adversaria anatomica,’’ compnsing the substance of 
his communications to the Academia Therein are contained some of his independent 
discoveries, more especially, as Nicholls points out, “in connection with the muscles 
of the hvold bone, the imila and the larynx ’’ 

After some tune, Morgagni resigned his position at Bologna and went to Padua 
and Venice, at which universities he continued his anatomic studies for the space 
of two to three jears He then moved to his native town, Forli, and began the 
practice of medicine Although Morgagni was successful at the physician’s art ho 
did not enjov the practical aspects of medical practice, and, therefore, on the death 
of Doiiicnlcho Giigliclniini, he accepted a chair of theoretical medicine in the Uni 
versitv of Padua made v’acant when Antonio Vallisnisci succeeded to Giiglielmini’s 
post 

Thus began Morgagni's long and uninterniptcd academic career, for he taught at 
Padua until his death fiftj-one jears later After three vears he was appointed by 
the Venetian Senate to the chair of amtomv at Padua made vacant bv the death of 
Michel Angelo Molinetti This was the most distingiiished po'ition on the faciiltv, 
and among the renowned anatomists he succeeded were Vesvimc^ Pallopnis Gas'-enus 
and Spigelius 


p: 1 



Morgagni was popular with his students, and his distinguished friends, according 
to Pettigrew, included King Charles Emanuel III of Sardinia, and Popes Clement 
XI, XII, and XIII and Benedict XIV In his own profession he enjoyed an inter- 
national reputation and was esteemed hy Valsalva, Alhertini, Lancisi, Verheyen, 
Heister, Euysch, Boerhaave, Mead, Sdnac, Haller, Meckel, Le Clerc, Fantoni, 
Nigrisoli, Michelotti, Mohnetti, and numerous others 

Morgagni was the recipient of scientific honors from all Europe He was elected 
a member of the Academia Haturae Curiosorum in 1708, the Eoyal Society of London 
in 1724, the Academy of Sciences of Pans in 1731, the Imperial Academy of St 
Petersburg in 1735, and the Academy of Berlin in 1754 

Apart from his scientific studies, Morgagni was a man of unusual attainments 
He wrote on philology, archaeology, literature and history Nicholls mentioned 
these works as typical Morgagni’s letters to Lancisi on the “Manner of Cleo 
patra's death,’’ “Commentaries’’ on Celsus and Sammonicus, and notes on Varro, 
Alpmus, Vegetius, Columella, and Vitruvius, as well as archaeologic papers on the 
districts around Eavenna and Forli 

It was not until 1761, when Morgagni was seventy-nine years old that his monu- 
mental work, “De sedibus et causis morborum per anatomen indagatis libri 
quingue,’’ was published This work has immortalized Morgagni as the father of 
pathologic anatomy, chiefiy because the records of post-mortem descnptions are 
correlated with clmical observations on a grand scale in addition to the fact that 
he was the first to descnbe many diseases Before Morgagni’s work was published, 
the standard printed work on the subject was the “Sepulchretum” of Theophilus 
Bonetus, published at Geneva three years before Morgagni himself was bom This 
work contained what was known about morbid anatomy up to the date of the pub- 
lication The more Morgagni studied the “Sepulchretmn,’’ the less satisfied with 
it he became and finally he concluded to supplement it with his own observations 
As was the custom of the time, Morgagni wrote his observations in the form of 
letters to a friend, a procedure that resulted in the production of seventy letters 
The letters were then returned to Morgagni, were revised and published in a huge 
work of five books 

The five books of “De sedibus et causis morborum’’ deal with (1) diseases of 
the head, (2) diseases of the thorax, (3) diseases of the abdomen, (4) diseases of 
a general nature, and diseases requiring surgical treatment and (5) such thmgs as 
were added to the other four books 

The work is based on the results of 640 postmortem examinations, generally 
occurring in his own experience but occasionally taken from the unpublished notes 
of Valsalva and Albertini 

Morgagni devoted several letters of “De sedibus’’ to a study of the diseased 
heart, in which he accurately descnbed the principal cardiac lesions which he found 
after the death of his patients We have chosen to reproduce his classic descrip 
tions of (1) mitral stenosis, (2) heart block, (3) calcareous stenosis of the aortic 
valve with regurgitation, (4) coronary sclerosis, and (5) aneurysm of the aorta 
As we have noted m our study of Heberden, Morgagni also included an early 
description of angina pectons, which he noted in 1707, and published in his “De 
sedibus’’ in 1761 (vol 1, p 282) Morgagni observed that certain disorders, such 
as asthma and dyspnea, formerly considered to be the result of pulmonary disease, 
also might be caused by diseases of the heart He suggested the possible relation- 
ship, as did many of his predecessors, of syphilis to aneurysm He also descnbed 
rapture of the heart, but did not mention the cause of this condition He also de 
scribed vegetative endocarditis 


[ 174 ] 



Nictiolls called attention to the fact that Morgagni “came fat short of estahlish- 
ing a complete system of Morbid Anatomy ’ ’ Morgagni could not entirely shake 
himself free from the erroneous conceptions of disease prevalent m his day Although 
the microscope was in use before his time, as we have shown, he does not appear 
to have used it in his investigations However, by basmg his views on personal ob- 
servation and making an effort to harmonize clinical manifestations of disease with 
the morbid appearances of diseases, Morgagni established a firm basis for those great 
prmciples that underlie modem methods of scientific research 

Blorgagni’s death occurred on December 5, 1771, when he was at the advanced 
age of nmety The citizens of Pork erected a bust to him in the pnncipal palace 
of the town in 1763 In Dryden’s “Oedipus,” the play he wrote with Nathaniel 
Lee, arc found the lines which provide an excellent strophe on the list years of 
Morgagni 

“ Of no distemper, of no blast he died. 

But fell like autumn-fruit that mellowed long, 

Ev’n wondered at because he dropp’d no sooner 
Fate seemed to wind him up for fourscore years 
Yet freely ran he on ten winter’s more, 

’Till, like a clock worn out with eating time, 

The wheels of weary life at last stood still ’ ’ 

(Quoted by Pettigrew) 



THE 


SEATS and CAUSES 

o r 

DISEASES 

INVESTIGATED BY ANATOMY. 

IN FIVE BOOKS, 

CONTAINING 

A Great Variety of DISSECTIONS, with Remarks. 

TO WHICH ARE ADDED 

Very Accurate and Copious INDEXES of the 
Principal Things and Names therein contained 

Translated from the Latin of 

JOHN BAPTIST MORGAGNI, 

Chief Profeflbr of Anatomy, and Prefidentof the Univcrfity at Padua, 

By BENJAMIN ALEXANDER, M. D. 

IN THREE VOLUMES 

VOL. 1. 


LONDON, 

Printed for A Millar, and T CADtii, his SucccITor, m the Suani, 
and Johnson and Pavne, m Fater-noller Row 
MDCCLXIX. 




closely, out of the body The blood was also black and giumous in the 
ventiieles of the heait, yet not in veiy gieat quantity The light vahuila 
mitialis was white, and in like mannei some of the semilunar valves 
the foimei weie much haidei than usual, and the latter a little so but 
in both mitral and semilunai, the membianous natuie had degeneiated 
almost into the natuie of a ligament In the middle and posterioi suiface 
of the heait, a kind of little membiane piotiuded, of a white colour, and 
look’d like the lemains of an hj'-datid On the light auiiele exteinally, 
also, weie some white spots But the aoita and othei vessels, as fai as 
I could see, weie accoiding to then natiual appearances 

27 It does not escape me, that j'oii may think this man’s death is lalliei 
to be imputed to a syncope, than to an apoplexy, as well when you coii- 
sidei the celeiity of it, as the sudden coldness of the body at that hot 
season, and in bed, oi even the appearances observ’d in the heart But, 
to begin with these last, and to compare them with the quantity of blood 
found within the cranium, we certainly find gieatei maiks of disoidei 
in the hearts of those, who had not the slightest appearance of fainting, 
and much less the most violent sj^icope And Galen has taught us, that 
an apoplexy may be foim’d fiom such an abundance of blood within the 
cianium, though I have nevei seen any other ease of the kind that I le- 
inembei Galen’s (n) words are, “By this means apoplexies are brought 
on, to wit, by much blood rushing tumultuously into the piineiple of anima- 
tion ” Nor did Petrus Salius (o), who first wrote a separate chapter on 
the sanguineous apoplexj’-, as I have mention’d in the former letter (p), 
imagine, that the disorder was, in general, brought about by other means, 
in the cerebrum, than from “too great a repletion of the veins, arteries, 
and smusses, with blood, for which reason a very great stiictuie is 
bi ought upon the brain, wheieby, not only the free passage of the spirits 
IS prevented, but they are even choak’d up, and suffocated thereby, 
so that sense and motion aie suddenly lost, and the intelligent faculties 
are suspended that is, a true and exact apoplexy succeeds ’’ And, 
indeed, such a quantity of blood could not be collected in all the vessels 
within the cranium, but that the soft substance of the cerebrum and 
cerebellum must be violently compressed, both from within and fioiii 
without, the small vessels also, wliieli escape the senses, being stieight- 
en’d, the circulation of the blood is intercepted, and consequently the 
secretron of spurts, which cannot happen without it, is prevented foi 
as there is no vacuity in the cranium, and the bones of it are incapable 
of giving way, the whole force of the pressure must be expended on the 
brain These things cannot happen to the cerebellum, as it seems, and as 
I have already said (g), rvithout a sudden suffocation of respiration and 
the motion of the heart, being the consequences thereof, that is, AVith- 

(n) Vid apud Salium, de Affect partic c2 

(o) Ibid 

(P) n 1 

(<Z) Bpist 2 n 24 


[ 178 ] 



out sudden death and tins death ]f you would i athei have it so, ii oiu 
a syncope, hut a syncope that uould pioceed fiom the head and not 
fiom the heait, or if fiom the heart also, on account of the appeaiaiiccs 
spoken of, yet, at least, ceitainly moie fiom the head, than fiom the 
heait But wherever theie is a syncope, fiom vhencesoevei it pioceeds 
theie IS no reason to wonder at the sudden coldness of the body though 
I should lathei suppose, that it vas only a diminution of warmth, yhich 
seemed to a voman uho uas heiself vaim, to be cold And, as fai as I 
can judge, you would not eii much, if you .should call lhat kind of 
sMicope, which Herophilus (?) seems to ha^e paiticulailv pointed out an 
apoplexy fiom the eciebcllum foi he sajs, “When sudden death hap- 
pens without am manifest cause, then it is owing to a palsy of the 
heait ” for nhat an apoplexy fiom the eeiebium does in other paits 
of the body, the same an apoplexy fiom the ceicbellum does in the 
heait but in an apoplexy nhich pioceeds both fiom ceiebium and ceie- 
bellum at the same tunc, motion is destioy’d in all paits of the body at 
once And such, I think, nas the case undei eonsideiation since theie 
was eMdently a mateiial cause of compiession upon them both, noi did I 
find that any of those sMiiptoms had pieccded, which aie gcneially ante- 
cedent to a SMicope fiom the heait oi am of its iieaieM Aossels 



had not wish’d for me to be then companion, in the cure of this lefractory 
disorder, less than the patient himself, made no sciuple to pionounce, that 
it aiose fiom the nutation of the hypoehondiia And indeed, as you have 
it also in this section of the Sepulehietum (m), Iheie is extant in Galen a 
history of a eeitain giammaiian, “who, having abstain’d too long fiom 
food, became epileptic, fiom no othei cause than bile ” And examples aie 
veij'- common of adults (it), not onh of childien (o), who have been 
tioubl’d with epilepsies, fiom woims haiboiu’d in the intestines And to 
this puipose also is that obsei\atioii of Spigellius (p), on a Avhelp thus 
kill’d by Avoims, not veiy unlike to which, is that foimeily Aviitten by me 
to Vallisneii, and by him publish’d (q) And you knoy that this disoidei 
often aiises, also, fiom otliei yisceia of the bellv being diseas’d, which the 
section, that I have alieady quoted, eonfiims (?) 

But although that kind of euie Avas applied to my felloAv-citizen Poggi, 
with mj^ assent, which was piopei to open, cleanse, and lelax, the hj^po- 
chondiia, yet, nevei theless, the accessions still letuin’d fiequently, so 
that we now began to feai, lest tlie head itself liad also conti acted the 
injuijq especially as, upon a veiy quick tuin of the head, the epileptic in- 
sults leenii’d, and left a sense of Aveiglit AVith stupidness in the head, 
and fiequently some blood came, togethei with the mucus, fiom the nose 
Wheiefoie, as in the beginning, they had alieady diawn blood once and 
again fiom the aim, noi had omitted to giye such tilings as aie geneially 
of use to the head, I peisuaded them to let blood be taken ay ay fiom those 
yeins, which lie about the anus also, and that seveial things should be 
given internally, ivlnch aie lecommended as extiemel}^ piopei against this 
disease, by the most excellent physicians These lemedies, howei^ei, y eie of 
no adA'antage, but the bleeding, AA'hethei it leliev’d the head, oi lathei 
those Ausceia AAdiieh aie seiv’d AAuth blood by tlie A^ena poitaiiim, y^as so 
fai of advantage, that foi a shoit time the paioxvsms Aveie quiet When, 
theiefoie, they letuin’d again moie fiequenth", it Aims of use to make the 
patient sit up, sometimes to i ub the Ioaa'^ci limbs, and sometimes to tie tliem 
alternately Avith bandages thioAAUi lound about, and sometimes to fix cup- 
ping-glasses Avithout scaiification, and piesently to vex the patient bt 
taking them oft, foi thus he seemed to haA'-e a loiigei intei mission fiom 
his paioxj^sms And I Avas even assui ’d, that AAdien they sometimes attack’d 
him much moie often, the spiiit of salt ammoniac, applied to the nostrils, 
had diiven them aAvay as they AA’^eie coming on, oi, CAmii ydien they yeie 
already, in a mannei begun, had suppiess’d them, although the patient 
Avas entiiely Avithout the poAvei of smelling They Aveie, foi the most pait, 
very slioit, but by no means slight Foi distoitions of the CA^es, agitations 
of the limbs, and a suspension of all the senses, ahvaA^s accompanied the 

(in) Sect 12 in scliol ad obs lO 

(n) Ibid schol ad obs 41 (o) Obs ead § 2 & schol ad obs 15 in additam 

(p) Ibid obs 41 § 1 (d) Consideraz in a la gener de A'-ermi 

( 1 ) Obs 39 cum schol 

[ 180 ] 



attack oftentimes tlieic iias a stiangnlation, and that sometimes 10111 d 
togethei \\itli a steitoi and e\en now and then an in\oIiuitai\ eHlux of 
mine attended But lie was eveeedingh bad tliat dav on wtneh the solstice 
liappen’d, and ni like niannei that on which the eclipse of the sun hap- 
pen ’d 

And though you nia\ suppose this might be by chance, ^ct lou cannot 
suppose it meielv accidental, that when the (piantitv of uiiiic was cithei 
iiatuiallv or aitificiallr encieas d (s), the epileptic palox^snls not onlv 
became not slight ei, but weie even \civ fieciuentlv cxaspeiated Foi we 
weie obhg d to ha.\e icgaid to this excietion sometimes when a sudden 
difficult! of bieathing lous d tlie patient, as be was beginning to sleep and 
compell d him to sit up, which s\mptom. doubtless ga\e us some suspicion 
of a diopsv of the thoiax, and the moie so, because the patient told us 
that his light leg had, foi a long time past, been accustom d to swell a 
little with watei, and that e\en tlien which, wlien he told us. we examin d 
into, the swelling was ascending up the thigh But it was easv to eneiease 
the (piantit! of uiine, liy obcious and innocent lemedics and theiefoie to 
diminish the tumoui, and that suspicion, whicli was atleiwaids enliieh 
lemoc'd, but not so the force of the att.icks wliieli, fiom the oneie.is’d 
atllux of mine, and that of itself, sometimes opaque, and blackish was so fai 
liom being weaken d. 01 diminish d, that ercii on the contian. as I said 
abo\e, the\ gicw stiongei and sliongei Wlien 1 he.se tilings, and otheis, 
wliicli loi tlie sake of mv piomisd biCMtc I pass o\ei weie of no efiect 
•igainst tlie inioads ol tins disease, and e\cn such as li.id been sometimes 
useful to K’taid 01 supjncss them as I said abo\e, weie now of no ad\an- 
tage, as thc\ did not (onliniie to afioid these efieits, theie was one tlniiir. 
howe\el. 



mended to dissolve, and piomote, the cneulation of the blood, in vain, 
upon giving the opium again, the qniet nights again letuin’d, and 
diminish’d that inequality of the pulse and, by the continu’d use of opium 
eveiy night, it was entiiely leniov’d, and even the foimei laiity was 
dimmish ’d 

But, peihaps, you will suspect, whethei the laiity of the pulse be, in fact, 
a veiy uncommon symptom, to lemain aftei an epilepsy, in hypoehondiiae 
patients, when you shall have compai’d tins obseivation of mine with that 
of the celebiated Geibezius (t) which desciibes the pulse of a stiong 
hypoehondiiae man, “who was now and then subject to slight epileptic 
paioxysms,’’ even when he was in health, “as being so veiy slow, that be- 
foie the subsequent pulsation follow’d that which went befoie, thiee 
pulsations would eeitainly have pass’d in anothei healthy peison ’’ But 
to 1 etui 11 to my subject, aftei that no fit had now letuined foi thiiteen 
days, and the use of opium was inteimitted, the fiist night indeed was not 
bad, but the following ones, by leason of the continual watching, and 
1 estlessness, and at length by leason of that difficulty of breathing, 
which I spoke of above, weie exceedmglj’- tioublesome, so that we weie 
oblig’d to have leeouise again to opium, in oidei to piocuie quiet nights, 
which nothing but opium would pioeiue And, to compiehend all in a 
few woids, that the attacks of the disease, fiom being veiy fiequent, 
as they had happen’d eveiy day, in the month of June, had been so fai 
1 educ’d in then numbei, that but one happen’d in July, one in August, 
nor moie in Septembei, and aftei that none in the two next months at 
least, and upwaids, till I depaitcd to teach medicine pnbliclj’’, we judg’d 
was owing to the use of opium, given oppoi timely, sometimes eveiy night, 
sometimes ei’^eiy othei night, and at length at the mteivals of many 
nights Foi by that medicine we weie able to appease the tumultuaiy 
motions, which aiose, and fiequently by a veiy manifest sensation, fiom 
the hypoehondiia, to the thoiax, and head, and by this means piocuie 
a tiuce, both foi natuie and ait, and this gave us sufficient time to 
cleanse and confiim the hypoehondiiae visceia, which we had deteimmed 
to do, m the beginning, but m vain attempted, among those fiist continual 
tumults, with which the patient was haiiass’d and fiom these visceia 
alone, and not fiom watei being ledundant m the biam, that these sudden 
commotions aiose, this histoiy, oi I am much deceiv’d, indeed, evidently 
shews 


(t) Eph N C Cent 7 in Append 


[ 182 ] 



LETTER THE TWENTY-THIRD 

TREATS OF PALPITATION AND PAIN OF THE HEART 

(Description of Calcareous; Stenosis of the Aortic VaUc v,ith Regurgitation] 


8 A T\oman, a little voungei than that last deseiib d. complain d in 
the same hospital of a palpitation of the heait sometimes, but ahiavs of 
a difficiiltv in hei bicath, mIiicIi she could not dia'w but with hci neck ciect 
and still moie of so gieat a stieightness and anxietv at hci heait that 
ici\ often she seem d pist at the point of death Some siippos d hei to 
labour undei a dropsi of the peiieaidnim Her pulse ne^er was intci- 
mitting, but hei ^elns wcie huge She died at the time that the genital 
paits of a woman wcie wanted to finish the public demonstiations of the 
'\eai 3731, a little befoic the middle of Mai eh 
The thoiav and belly being open d, some quantity of watei was found 
111 both caiities, but thcic was no diopsv of the peiicaidium The \al\es 
of the aoita weie induiatcd, and one of them e^cn bom The tiiink of 
the alien ilsclf sliew ’d, up and down on its inlcinal surface, cithei some- 
lliing bom, 01 something leiging to the natuie of a bone so that the jiait 
of the alien which went thiough the bclK, and which I disscded aftei 
demonstiation of the genital paits, was m the same state Xoi did I find it 
bom onlj ,it llic side of the infeiioi mesenteiic aiten and in othei jihues 
hut cion at the loiv dnision of it into the iliacs and in seieial ]i1aeos it 
was iincipial, and heie and theie of a whitish coloui, as it geneially is 
when It begins to boeome bom 

') It (eitauih cannot be denied that the aoita in the state I ha\<‘ <le- 
sciilid it must losist the blood as it is dineii In the heait, .ind loi that 
le.ison. lie .ible to cieato a jialjut.ition .i difiieult\ of hi eat lung ami that 
sense of stieiglituess witli wliieli the woman was toimented But at the 
same tune it is nectssan to deelaic wh\ out of so gieat a numhei oi pti- 
''Oiis 111 wliuiii tlicie w.is an ,ioit<i of this Kind <is ] han all cadi wiiftni 


to \ou and shall wide heieaftei mam of them, eeit.iiiih, did not laiiom 
undei these disoideis at .ill oi. at le.ist not so lehemeiith Ami in oidu 
to do this othei eucuuistaiUHv without doubt, must be added to the di'^ 
oidci o! the .loit.i wlmli did « \isi in this worn. 'll .md did not esisl in fin 
otluis, as foi iiisl.ime .1 difieidit fault in theoig.nis oi .i difunut <on- 
stdution of ilu blood difieitiit «iu.lntd^, .'iid otln i things oi ■ similei Kind 


hi '-uh s 

ill It \\i 

n\.\\ not 

SCI m 

to be 

I'Vt of 

tin !U1 

\l N 

.Uld 

1 olU lllslons 

ib, id\ 

puniU d 

out 

o,i\ 

. .'fli 1 

' \iol 

gi* i* <- 

■’hm.' t 

he ' 

Ol t. 

W.'v 1- 


ind th, 

h' ”, It 

V. 1 J 

W 

loidoi 

ti< hi 

'M'l’d 

''i‘ 1!' 

*1.,* J 

} 


1\ ' O ' 


•liw.'Xs bunging m !"f nioi. I'ljuisib 
“^o ui .'U oh-. i-v..tion of V< idii* -in*- 
I nf p diot 1 i<>n oi ftj, jj, : ..nd . • 

to l»i in’* M Ih b .n\ i. i t’ * '< 

(I* ' vln'ii > ,h,; V tj. igji.ji;,;, 5 ’>1 , * d 


' r. ' I 1‘ : i 



disordeis, had been, in the beginning of them, very much subject to a 
palpitation of the heait, the celebiated Plancus (n) not only found the 
aorta in many places become bony, but also both the eoionaiies of the 
heart, and the heait itself very laige, paiticulaily its light auiiele, which 
was the laigest and stiongest of all and fiom hence you may easily 
perceive, that, in consequence of this one disoidei, the heait might be 
moie vehemently mutated by the blood being moie stiongly impell’d into 
the subjected ventiicle, and may the less wondei, if in the ohseivatwn of 
Giassius the youngei, spoken of alicady in this woik (o), it shall per- 
haps appeal, that nothing else could be the cause of the palpitation, but 
the light auiicle being enlarg’d to tlie double of its usual capacity 
Finally, not to detain you too long, in a woman of an illustiious family, 
whose palpitation of the heait was so gieat, and so constant, as to be 
heaid by those who stood neai hei, and be discern 'd by those who were 
at some distance, the celebiated Cohausen (p) not only saw the aorta 
entirely callous, but he even saw in tlie heait itself, noi to mention the 
lungs, sen 1 111, and the blood viscid and mucous 

Wheiefoie, in the woman, also, spoken of by me, besides the aorta being 
heie and theie bony, oi inclining to a bonj’- state, tlie valves of it aie also 
to be attended to Poi as one of these was bony, and the otheis indurated, 
so being, of consequence, less yielding to the blood, they might enciease 
the obstacles to its exit, and, on the othei hand, not sufficiently pi event its 
letuin, when, soon after, repuls’d bj'- the eon traction of the great arterj^, 
so that, as some portion of it return’d into the left ventiicle of the heart, 
when this ventiicle ought to receive the blood that uas coming in from the 
lungs, it would necessaiily happen, that the letuining portion, as Avell as 
the portion which had not been extruded just before, must occupy some 
part of that space, which, fiom the design of natuie, was entirely due to 
the blood that was coming in from the lungs Which cncumstance, finally, 
could not but overload both the lungs and the heart, and compel the latter 
to throw out, every now and then, with a great impetus, the blood that 
stagnated in it 

An d these things, which reason seems to lead us to, are confirm’d by more 
than one observation of the anatomists Thus Vieussens (g), in a man 
and a matron, both of whom had been long troubl’d with a palpitation of 
the heart, and incapacity of lying down with the head low, join ’d witli an 
inequality of the pulse, relates, that the aorta and its valves were found 
to be bony in the matron, and in the man, tliat tlie aorta was very hard, 
and in a manner cartilaginous, and the valves not only bony, but also with 
then edges cloven asunder, and the same really become stony, I say leallj", 
lest you should, perhaps, imagine, that what was bony should have been 
taken for being stony in the heait, as it has happen’d sometimes in other 

(n) Epist de Monstr (o) Bpist IS n 4 (p) Commerc Litter A 1743 Hebd 21 n 

4 

(q) Traits du Coeur ch 16 


1384 ] 



places For besides those which will be mention’d below, yon will read 
of similar eases, heie, in the Sepiilchretnm, in obseivations which are 
pretty ancient , as that of Grregonns Horstins the elder (i ) , who found 
calculus concreted fiom tartar adheimg to the membianous substance 
of the valves” of the light ventricle of the heait, and that of Jo Georgius 
Gieiselius (s), who saw one of those valves of the aorta which we are 
spealang of “half-consum’d, and lost, and that pait wheie it adher’d to 
the aiteiy even friable into a kind of sand”, and theie was “a kind of 
white paiticle, like the nail of a little fingei,” which was the part of the 
valve that the blood had lately torn away, the heait being in both of them, 
who died after a palpitation, veiy much enlaig’d, in the same manner as 
the left ventricle had been in that man of Vieussens 


LETTER THE TWENTY^FOURTH 

TREATS OF PRETERNATURAL PULSES 

[Description of Coronary Sclerosis] 


16 In an old man, who was of a lean habit, and whom I dissected in 
the month of Deeembei of the yeai 1743, the pulse had been weak and 
small, but not intermitting, when, on account of an tncm cei ated hernia, 
as it IS call’d, he was bi ought into the hospital at Padua And notwith- 
standmg it was out of my power ceitainly to inform myself, whether the 
pulse had been in that state before this disorder came on, or whether it 
was rather brought on by this disease, ;)oin’d with an inflammation of the 
intestines, to such a degree, that a speedy death prevented any method 
of cuie being attempted, yet the appearances which I observ’d in many 
parts of the body, and paiticulaily in the heart itself, and demonstrated 
to a very crowded circle of students, are of such a nature, that I cannot 
judge them to be unworthy of being communicated to you 
As I examin’d the external surface of the heart, the left coronary artery 
appear’d to have been chang’d into a bony canal, from its very origin 
to the extent of many fingers breadth, where it embraces the greater part 
of the basis And part of that very long branch, also, which it sends 
down upon the anterior surface of the heait, was already become bony to 
so great a space, as could be cover’d by three fingers plac’d transversely 
For which reasons, a passage was open’d on both sides, not through a 
membianous canal, or one which was made somewhat hard, here and there, 
by disjoin’d bony lamellae, but through a continued bony tube, which 
for hardness might with justice have been compai ’d with anj^ other hard 
bone, except that in some places it was less hard, though those were very 
small, a nd inconsiderable, and resembl’d the transverse lines form’d by the 


(1) Obs 35 (s) Obs 13 


ri85i 



knots of a slendei’ reed The heait then being open’d, and some polypous 
concretions being taken awaj^ although I saw the tubeicles of the valves 
of the gieat aiteiy much haidei than usual, and almost bony, yet I found 
nothing bony eithei in them, oi in any othei valves, oi in that aiteiy neai 
the heait But at some inteival fioni the heait, and at the oiigins of the 
upper aiteries, and fiom thence doivmvaids quite to the divisions into the 
lilacs, the internal suiface of the aoita ivas fiequently unequal on account 
of yeiy hard bony laminae, many of ivhich equall’d in bigness the nail 
of a man’s thumb yet I found the thin inteinal membiane, by which 
all these ossifications weie cover’d, to be hint only in one place, a thiekish 
kind of liumoui showing itself theie in legaid to nliieh, and the seat 
itself of these laminae, I shall liave a more convenient oppoitunit}’' of 
speaking heieaftei (x), and telling you what I obseiv’d in this man, and 
in othei s And bony scales n eie not wanting, eithei at the division into the 
subclavian and eaiotid ai tones, on the light side, oi in the iliacs, noi 3 ’et in 
the splenic in paiticulai, in nhicli they weie found veij^ thick, quite to the 
spleen Neveitheless, within the cianium, and in like maniiei, both in the 
uppei limbs, and in the lonei limbs, I obseiv’d nothing bony in the 
ai tones, although this class of vessels was, in the limbs, moie film and 
haid than usual, and peihaps even somewhat widei tlian they geneially 
are and while I was cutting into these ai tones, I san that the blood which 
lemain’d in the ciiual vessels was not fluid indeed, -^et not pohqious 


LETTER THE TWENTY-SIXTH 

TREATS OF SUDDEN DEATH, FROM A DISORDER OF THE 
SANQUIFEROUS VESSELS, ESPECIALLY THOSE 
THAT LIE IN THE THORAX 

[Description of Aneurysm of the Aorta] 


9 A man who had been too much given to the eveicise of tennis and the 
abuse of wine, was, in consequence of both these iiiegulanties, seiz’d 
with a pain of the light aim, and soon aftei of the left, join’d vath a 
fevei Aftei these theie appeal’d a tumoui on the uppei pait of the 
sternum, like a laige boil by which appeal aiiee some vulgai suigeons being 
deceiv’d, and eithei not having at all obseiv’d, oi having neglected, the 
pulsation, applied such things as aie geneially us’d to bung these tumouis 
to suppuiation, and these applications weie of the most violent kind 
As the tumour still enci eas’d, othei s applied emollient medicines, fiom 
which it seem’d to them to be diminish’d, that is, fiom the fibies being 
rubb’d with ointments and lelax’d, wheieas they had been befoie gieatly 
irritated by the applications But as this ciicumstance i elated lather 


(a:) Epist 27 n 22 


[ISC] 



to the common mtegnments, than to the tumoui itself, or to the coats that 
weie pioper theieto, it not only soon lecovei’d its foimei magnitude, but 
even was, plainly, seen to enciease eveiy day Wherefore, when the patient 
came into the Hospital of Incurables, at Bologna, which was, I suppose, in 
the yeai 1704 , it was equal in size to a quince, and what was much worse, 
it began to exsude blood in one place , so that the man himself was very near 
havmg bioken through the skin (this being reduc’d to the utmost thinness 
in that pait, and he being quite ignorant of the danger which was at hand) 
when he began to pull off the bandages, for the sake of showing his disorder 
But this circumstance being observ’d, he was pi evented going on, and 
01 del’d to keep liimseK still, and to think seiiously and piously of his 
depaiture fiom this moital life, which was very iieai at hand, and in- 
evitable And this leally happen’d on the day following, fiom the vast 
piofusion of blood that had been foietold, though not so soon expected 
by the patient Neveitheless, he had the piesence of mind, immediately 
as he felt the blood gushing forth, not only to commend himself to 
God, but to take up with his own hands a bason that lay at his bed-side , 
and, as if he had been leceiving the blood of another peison, put it be- 
neath the gaping tumoui, while the attendants immediately lan to him 
as fast as possible, in whose aims he soon aftei expired 
In examining the body befoie I dissected it, I saw that there was no 
longei any tumoui, inasmuch as it had subsided after the blood, by 
which It had been lais’d up externally, had been disehaig’d The skin 
was there bioken thiough, and the paits that lie beneath it with an 
apeituie, which admitted two fingeis at once The inembrana adioposa 
of the thorax discharged a water dui mg the time of dissection, with 
which some vessels weie also tuigid, that were prominent, here and theie, 
upon the suiface of the skin in the feet and the legs In both the cavities 
of the thoiax, also, was a gieat quantity of water, of a yellowish colour 
And theie was a laige aneuiism, into which the anterior pait of the 
cuivatuie of the aorta itself being expanded, had paitly consum’d the 
upper pait of the sternum, the extremities of the clavicles, which lie up- 
on It and the neighboring iibs, and paitly had made them diseas’d, by 
bunging on a canes And wheie the bones had been consum’d or affected 
with the canes, theie not the least tiaees of the coats of the artery re- 
main’d to which, m other places, a thick substance every wheie adher’d 
internally, lesembling a diy and lund kind of flesh, distinguish’d with 
some whitish points, and this substance you might easily divide mto 
many mcmbiaiies, as it weie, one lying upon anothei, quite different in 
then natuie fiom those coats to which they adher’d, as they were evi- 
dently polypous And these things being accurately attended to, nothing 
occui ’d besides that was worthy of remark 


[ 187 ] 




1761 

^ ^'ERCOSSIojv; 







JOSEPH LEOPOLD AUENBRUGGER 

(1722 1809) 

[Durdles ] ‘Now, looTcee here You ‘pitch your 'note, don’t you, Mr Jaspei^’ 

[Mr Jaspei ] ‘Yes ’ 

[ Durdles ] ‘ So I sound for mine I take my hammer, and I tap I tap, tap, tap 

Solid’ I go on tapping Solid still’ Tap again Holloa’ Hollow' Tap again, peise 
vering Solid in hollow' Tap, tap, tap, to try it better Solid in hollow, and inside 
solid, hollow again' There you are' Old ’un aumbled aiuay in stone coffin, in vault'’ 

— From The Mysteiy of Edwin Brood, by Charles Dickens 


/'Y^^^'CUSSION as a means of testing whether walls were solid or whether they 
cC covered hiding places, whether barrels were empty or full and for many other 
purposes, must have been in use since the beginnings of civilization It is surprismg, 
therefore, that no one before Auenbrugger seems to have thought of using percussion 
of the human body as a means of diagnosis 

Joseph Leopold Auenbrugger was bom at Gratz in Stryria, Austna His father 
was an mnkeeper, and the younger Auenbrugger himself was an accomplished 
musician i These two facts had no little significance m his development of percus- 
sion The technic he probably learned from tapping wme barrels m his father’s inn 
and his good musical ear helped him greatly in the interpretation of sounds 

In due course Auenbrugger studied medicine at the University of Vienna, where 
he was the pupil of van Swieten who at an earlier date had been a student of 
Boerhaave at Leyden Van Swieten had been called from Holland to the Austrian 
capital by the Empress Maria Theresa He became court physician and because of 
his royal backing he was able to found the great medical school at Vienna 


From 1751 to 1762 Auenbrugger was connected with the Spanish Hospital at 
Vienna, first as assistant, later as physician In 1754 he first noted the difference in 
sounds produced by striking the wall of the chest in various places Hot until he 
had pursued the line of clinical research this opened up to him for seven years did 
he publish his results and observations The 95-page book, “Inventum novum ex 
percussione thoracis humani ut signo abstrusos mterm pectoris morbos detegendi,” 
was published in Vienna in 1761, the same year that brought forth Morgagni’s “De 
sedibus et causis morborum per anatomen indagatis libri qumque ’ ’ 

After describing the sound produced by striking the chest of a healthy person 
in different regions, Auenbrugger gave a detailed account of his method of prac- 
ticing percussion Had he but applied his ear as well as his hand he would have 
anticipated Laeimec But he came near to the discovery of auscultation when, 
under part three of his Eleventh Observation in “On percussion of the chest,’’ he 
wrote “If at this time, while the patient is coughing and spitting, the palm of the 


^He vrote the libretto for Antonio Salieri’s Der Rauchfangkehrei , oder die unenthehr- 
’''’c Berrschaften aus Eigennutz, -nhich was presented at Vienna in 
1781 This libretto attracted the attention of the Empress Maria Theresa She asked 
him to write another, but Auenbrugger replied that he had something better to do than 
IP )vr^lG OpGJ*9.S 


[ 191 ] 



hand he placed over the site of the vomica, i e , over the place where its existence 
had been detected hy percussion— the noise of fluid within the chest will he suffi- 
ciently manifest ’ ’ 

It IS of interest to notice, especially, the diseases which he was able to detect 
merely by means of the preternatural sounds heard through percussion, diseases 
whose existence he was later able to confirm by studies at necropsy These diseases 
mcluded “scirrhus” of the lungs, vomica, empyema, pleural effusion, dropsy of 
the pericardium, extravasation of blood into the cavity of the pleura or pericardium, 
and aneurysm of the heart 

Auenbrugger’s discovery was ignored by those occupying the high places of 
medicine of his day Even his own teacher, Baron van Swieten, for whom Auen- 
brugger had the highest respect, was not impressed by the remarkable new aid to 
diagnosis The only well-known physicians in good standmg who appreciated Auen- 
brugger’s work at that time were Dr Stoll of Vienna, who both used and taught 
percussion from 1776 to 1784, and Charles G Ludwig of Leipzig The ‘ ‘Inventum 
novum” was translated into French by Eozifere of Montpellier in 1770 And al- 
though the book went through two French editions it seems to have been practically 
unknown until the clinician Jean-Nicholas Connsart, noted teachers and physician to 
Napoleon Bonaparte, revived the discovery 

It IS said that Corvisart had never heard of Auenbrugger and his ‘ ‘Inventum 
novum” until he read of it in the works of Stoll From that time on he practiced 
percussion with perseverance on living subjects as well as cadavers After twenty 
years of experience he translated Auenbrugger’s work and added his own voluminous 
commentaries to it m 1808, only a year before Auenbrugger’s death Corvisart, m his 
440-page translation, gave full credit to Auenbrugger as the discoverer of percussion, 
but Corvisart’s renown at home and abroad quickly placed the discovery of Auen- 
brugger on a high pinnacle In his preface, Corvisart said “I declare from ex- 
penence, that this sign of which I treat is one of the greatest importance, not only 
m detectmg disease, but also in curing it, and therefore merits first place after ex- 
ploration of the pulse and respiration ’ ’ (Quoted from Otis ) 

Notwithstanding the neglect of Auenbrugger’s sign during his own lifetime, it 
cannot be said that he was not appreciated He had a large practice, was noted for 
his philanthropy, had a genuine devotion to the science and the art of medicine, and 
had a high regard for the poor as well as the rich 

His life at home was happy He had fallen in love with Marianna von Priesters 
berg when he was a student, and he married her in 1754 They had two children, 
both daughters, one of whom was a remarkable pianist, and the other of whom was 
noted for her beauty and wit 

As has been mentioned, Auenbrugger had early found favor with the Empress 
Maria Theresa, and the Emperor Joseph raised him to noble rank in 1784, probably 
not because of his discovery but in recognition of his skill as a physician and his 
services to the public 

In the latter part of his life Auenbrugger lost the sight of one eye, but the other 
was so good that he could tell time by the town clock, which was a considerable 
distance from his wmdow Two years before his own death his beloved wife. Man- 
anna, died (They had celebrated their golden wedding anniversary in 1804 ) From 
that tune onward Auenbrugger took little interest in life, remained most of the 
time in his study and enjoyed only the company of his granddaughters His death, 
the result of a cold, occurred in 1809 He was in his eighty-seventh year 

»Liaennec was one of Ins pupils 


[192 3 



LEOPOLDI AUENBRUGGER 

MBDICIN^B DOCTonrs 
IN C^SABEO BBGIO NO<;OCOMIO NATIONUM 
HISJaNICO MEDICI ORDIE^Rir, 

INVENTUM NOVUM 


E X 

PERCUSSIONE THORACIS HUMANI 

UT SIGNO 


ABSTRUSOS INTERNI 

PECTORIS MORBOS 

DETEGENDI 



VlNDOBONJEf 

Tvrif JOANNIS THOM^ TRATTNER , CjES. Rbo. 
MaJEST, AVI-X. TyPOCRAPHI. 


MDCCLXI, 


ON PERCUSSION OF THE CHEST 

By 

LEOPOLD AUENBRUGGER 


PREFACE 

T HERE piesent the Reaclei with a new sign which I haie discoveied 
J- foi detecting diseases ot tJie chest Tins consists in the Peiciission of 
the human tlioiax, wheieby, aeeoiding to the ehaiactei of the paiticiilai 
sounds tlienee elicited, an opinion is foimcd of the internal state of that 
eavitj^ In making pulilic iiij'- discoveiies lespecting this matter, I have 
been actuated iieithei b'^ an itch foi wilting, noi a fondness foi speculation, 
but by the desiie of submitting to my biethien the fiiiits of se^en 3eais' 
obseivation and iefle\ion In doing so, I have not been unconscious of 
the dangeis I must encountei , since it has alwaj’’s been the fate of those 
who have illustiated oi impioved the aits and sciences bj' then discoveiies, 
to be beset bj^ envy, malice, hatied, deti action and calumny 
This the common lot, I have chosen to undeigo, but with the deteiiiiina- 
tion of lefusiiig to eveiy one who is actuated bj' such motnes as these, all 
explanation of mj'’ doetiines What I have wiitten I have pioved again 
and again, by the testimony of my own senses, and amid laboiioiis and 
tedious exeitions — still guaidmg, on all occasions, against the seductive 
influence of self-love 


And heie, lest aiij’’ one should imagine that this new sign has been 
thoioughly investigated, even as fai as legaids the diseases noticed in mj- 
Treatise, I think it necessaiy candidlj^ to confess, that theie still remain 
many defects to be leiiiedied — and which I expect will be lemedied — b} 
caieful obseivation and experience Pei haps, also, the same obseivation 
and expel lence may lead to the discoveij^ of othei tiutlis, m these oi othei 
diseases, of like value in the diagnosis, piognosis and cuie of thoiaeie affec- 
tions Owing to this aelmowledged impeifection, it will be seen, that, 
in my difficulties, I have had recouise to the Conimentaiies of the most 
illustiious Baion Van Swieten, as containing eveiy thing which can be 
desiied by the faithful obseivei of the natuie, by which means I have not 
only avoided the vice of tedious and piolix wilting, but have, at the same 
time possessed mj^self of the fiimest basis wheieon to laise, most seeuiely 


fTnvpntum novum ex peicnssione thoracis humani ut signo ah^uisos mterm pect^is 
v\e®nnl 1761 Tra"s^tecl by John Forbes M D London, 1S24 Ke- 
printed from Sigenst, H E Bull Inst Hist Med 4 379-40S 1936 


[ 194 ] 



and creditably, the ludunents of my discovery In submitting this to the 
public, I doubt not that I shall be eonsideied, by all those who can justly 
appreciate medical science, as having theieby lendeied a giateful service 
to oui ait, inasmuch as it must be allowed to throw no small degree of light 
upon the obscuiei diseases of the chest, of which a more peifect knowledge 
has hitheito been much wanted 

In drawing up my little work I have omitted many things that were 
doubtful, and not sufficiently digested, to the due perfection of which 
it will be my endeavoui hencefoith to apply myself To conclude, I have 
not been ambitious of oinament in my mode or style of writing, being 
contented if I shall be understood 

Decevihei 31, 17b0 


FIRST OBSERVATION 

OF THE NATURAL SOUND OF THE CHEST, AND ITS 
CHARACTER IN DIFFERENT PARTS 

I 

The thorax of a healthy pel son sounds, when stiuck 

Scholium I deem it unnecessaiy to give in this place, any description 
of the thorax I think it sufficient to say, that by this term I mean that 
cavity bounded above by the neck and clavicles, and below by the 
diaphragm in the sound state, the viseeia it contains are fitted for their 
respective uses 

II 

The sound thus elicited (I) from the healthy chest, resembles the stified 
sound of a drum covered with a thick woollen cloth or other envelope 

HI 

This sound is perceptible on different parts of the chest rri the followrng 
manner 

1 On the right side anteriorly it is observed from the clavicle to the 
sixth true rib , laterally, from the axilla to the seventh rib, and posteriorly, 
from the scapula to the second and thud false ribs 

2 The left side yields this sound from the clavicle to the fourth true 
lib, anteriorly, and on the back and laterally, m the same extent as the 
other side over the space occupied by the heart the soruid loses part of 
its usual clearness, and becomes dull 

3 The whole steiriunr yields as distinct a soiuid as the sides of the chest, 
except in the cardiac region where it is somevhat duller 

4 The same sound is perceptible orei that part of the spinal column 
vliich contributes to form the chest 


[ 195 ] 



Svhohum The sound is moie distinct in the lean, and proportionably 
duller in the lobust, in veiy fat peisons it is almost lost The most 
sonoious legion is fiom the clavicle to the fouith iib anteiioily, lowei 
down, the mammae and pectoial muscles deaden the sound Sometimes, 
owing to the presence of muscle, the sound is dull beneath the axilla In 
the scapular regions on the back, owing to the obstacle affoided by the 
bones and thick muscles theie, it is also less distinct Sometimes, but 
rarely, it exists ovei the thud false iib— owing, I conceive, to a veiy 
unwanted length of tlie thoiacic cavity 

SECOND OBSERVATION 
OF THE METHOD OF PERCUSSION 

IV 

The thoiax ought to be stiuck, slowly and gently, with the points ot the 
fingeis, biought close togethei and at the same time extended 
SchoUum Robust and fat subjects lequiie a stiongei peicussion, such, 
indeed, as to elicit a degiee of sound equal to that pioduced, by a slight 
percussion, in a lean subject 

V 

During peicussion the shirt is to be diawii tight ovei the chest, or the 
hand of the opeiatoi eoveied with a glove made of unpolished leather 
Scholium If the naked chest is stiuck by the naked hand, the contact 
of the polished suifaces pioduces a kind of noise which alteis oi obscures 
the natural chaiacter of the sound 


VI 

Diuing the application of peicussion the patient is fiist to go on bieath- 
xng in the natuial mannei, and then is to hold the bieatli aftei a full 
inspiration The ditfeience of sound duiing inspiiation, expiiation, and 
the retention of the bieatli, is impoitant in fixing oui diagnosis 

VII 

While undei going peicussion on the foie paits of the chest, the patient 
IS to hold his head eieet, and the shouldeis aie to be thrown back, in 
order that the chest may piotiude, and the skin and muscles be drawn 
tight over it a clear sound is thus obtained 

VIII 

While we aie striking the lateial paits of the chest, the patient is to 
hold his arms acioss his head, as, theieby, the thoiacic paiietes aie made 
moie tense, and a eleaier sound obtained 

[ 196 ] 



IX 

When opeiatmg on the back, yon aie to cause the patient to bend for- 
wards, and draw his shoulders towards the anterioi parts of the chest, 
so as to render the doisal legion lounded, and for the same reasons, 
as stated in YIII 

Scliohum Any healthy peison may make expeiience of peicussion in 
his own person or that of othei sound subjects , and will thus be convinced 
from the vaiiety of the sounds obtained, that this sign is not to be dis- 
pised in foiming a diagnosis 

THIRD OBSERVATION 

OF THE PRETERNATURAL OR MORBID SOUND OF THE 
CHEST, AND ITS QENERAL IMPORT 

X and Scholium 

To be able justly to appreciate the value of the vaiious sounds elicited 
fiom the chest in eases of disease, it is iiecessaiy to have learned by experi- 
ence on many subjects, the modification of sound, geneial oi partial, pro- 
duced by the habit of body, natural conformation as to the scapulae, 
mammae, the heait, the capacity of the tlioiax, the degiee of fleshiness, 
fatness, etc, etc , inasmuch, as these vaiious ciicumstances modify the 
sound very consideiably 

XI 

If, then, a distinct sound, equal on both sides, and eommensuiate to 
the degiee of peicussion, is not obtained fiom the sonorous regions above 
mentioned, a moibid condition of some of the paits within the chest is 
indicated 

Sclwhwn On this tiuth a geneial rule is founded, and from this ceitain 
piedictions can be deduced, as will be shown in older Foi I have learned 
fiom much expeiience that diseases of the worst desciiption may exist with- 
in the chest, unmaiked by any sjmiptoms, and uiidiscoverable by any other 
means than peicussion alone 

A clear and equal sound elicited from both sides of the chest indicates 
that the air cells of the lungs aie fiee, and uncompressed either by a 
solid 01 liquid body (Exceptions to this lule will be mentioned in their 
place ) 

XII and XIII 

If a sonoious pait of the chest, stiuck with the same intensity, yields 
a sound dullei than natuial, disease exists in that part 

XIV 

If a sonoious legion of the chest appeals, on peicussion, entiiely destitute 
of the natuial sound — that is, if it yields only a sound like that of a fleshy 
limb when stiuck, — disease exists in that legion 

[ 197 ] 



Scholium The natiue of the indications above pointed out, will be 
understood by any one who attends to the difference of sound elicited by 
peieussion of the chest, and of the thigh, in his omi person 

XV 

The supeificial extent of this unnatuial sound (XIV) in a sonorous 
legion, IS commensuiate with the extent of the moibid affection 

XVI 

If a place, natuiallj'- sonoious, and now sounding only as a piece of flesh 
when stiuck, still letains the same sound (on peieussion) when the breath 
IS held aftei a deep inspiiation, — ^ive aic to conclude that the disease ex- 
tends deep into the cavity of the chest 

XVII 

If the same lesults (XVI) aie obtained both befoie and behind, on 
points precisely oiiposite, we aie to conclude that the disease occupies the 
whole diametei of the chest 

Scholium These vaiying lesults depend on the greatei oi less diminu- 
tion of the volume of an usually contained in the thoiax (lungs ) , and the 
cause which occasions this diminution, whethei solid or liquid, pioduces 
analogous lesults to tliose obtained by striking a cask, foi example, in 
diffei ent degiees of emptiness oi fulness the diminution of sound being 
piopoitioned to the diminution of the volume of an contained in it 

FOURTH OBSERVATION 

OF THE DISEASES IN QENERAL IN WHICH THE MORBID 
SOUND OF THE CHEST IS OBSERVED 

XVIII 

The pieteinatuial oi moibid sound oceuis in acute and chionic diseases, 
it always accompanies a copious effusion of fluid in the thoracic cavity 

Scholium It must be admitted that whatevei diminishes the volume of 
air within the chest, diminishes the natuial sound of that cavity, but we 
know fiom the natuie, the causes, and the effects, of acute and chrome dis- 
eases of the chest, that such a lesult is possible in these cases, and the fact is 
finally demonstiated by examinations after death The effect of effused 
fluids in pioducing the morbid sound, is at once pioved by the injection of 
watex into the thoiax of a dead body, in which case it xvill be found that 
the sound elicited by peieussion, ivill be obscuie ovei the portion of the 
cavity occupied by the injected liquid 


[ 198 ] 



FIFTH OBSERVATION 

OF ACUTE DISEASES IN WHICH THE CHEST YIELDS 
THE MORBID SOUND 

XIX 

The moibid sound which is obseived in acute diseases, occuis duiing 
then pi ogress, or at their teimination 
Scliohum This consideiation ought to lead all medical men to use 
percussion in acute diseases, as they will thereby be enabled to foim a 
more correct judgment, which iii such cases is always a matter of difficulty 
It has often occurred to me to see eases of acute diseases, apparently over, 
and imposing on the physician under the mask of intermittent or remittent 
fevers, and which have eventually ended in a fatal vomica oi fatal schirius 
of the lungs 

XX 

The preternatural sound which is perceived during the eouise of acute 
diseases of the chest, occuis most frequently in inflammatoiy atfections 
Scliohum The reason of this observation (XX) will be obvious to any 
one acquainted with the nature of inflammation The preternatural sound 
may also be obseived sometimes in epidemic exanthematous diseases, previ- 
ously to the eruption, — as was the case in the petechial epidemic of 1757, 
1758, 1759, and in the miliaiy epidemic of the present year (1760) In the 
latter instance, I obseived that the preternatuial sound, when once piesent, 
continued to the termination of the eiuption 

XXI 

The morbid sound which occurs towards the teimination of acute dis- 
eases, IS observed, when the excretion of morbid matter is not adequate to 
the severity of the affection 

XXII 

The morbid sound occur ring in inflammatory diseases is commonly ob- 
servable on the fourth day , it raiely piecedes, but often follows tins period 
Scliohum This sign occuis larety on the thud, and very often on the 
fourth, fifth, and seventh day — but never later It is observed in those 
inflammatory affections of the pleura or lungs, or both, which are accom- 
panied by a humid cough, but not in those attended by a dry cough, — 
such (eg) as the dry pleurisy, and inflammation of the mediastinum, 
pericardium, and heart At least in these latter affections, the sound is 
not observed, until such time as they verge towards a fatal termination, 
or have degenerated into obvious abscesses or vomicae 

XXIII 

The moibid sound increases, from the time of its appearance, according 
to the nature, severity, and duration of the disease, it dimmishes proper - 
tionablv to the nature, duration, and copiousness of the excretions 

[199J 



Scholium The progiessive augmentation of the pieteinatuial sound 
depends on the giadual deposition of the moibifie mattei, which I have 
often found in such quantity as to occupy the infeiioi two-thnds of the 
affected side 

XXIV 

The disease in which the pieteinatuial sound is once piesent, eithei 
proves fatal [on a decietoij’’ day, leckoning fiom its origin] , passes off 
with due excietion, oi terminates in othei affections 

XXV 

The following eoiollaiies aie the lesiilt of mj’- ohseivation of inflam- 
matoiy diseases of the chest, studied undei the sign of moihid lesonance 

1 The dullei the sound, and the moie neailj’’ appioachiiig that of a 
fleshy limb stiicken, tlie moie seveie is the disease 

2 The moie extensive the space ovei which the moihid sound is per- 
ceived, the moie eeitaiii is the dangei fiom the disease 

3 The disease is moie dangei ous on the left than on the light side 

4 The existence of the moihid sound on the supeiioi and anteiior pait 
of the chest (le fiom clavicle to the fouitli iib) indicates less danger, 
than on the inferioi paits of the chest 

5 The want of the natuial sound behind, indicates moie dangei than it 
does on the anteiior and supeiioi pait of the chest 

6 The total destitution of sound ovei one whole side, is geneially 
(passim) a fatal sign 

7 The absence of sound along the couise of the steinum is a fatal sign 

8 The entile absence of the natuial sound ovei a laige space in the 
region of the heait, is a fatal sign 

Scholium I have sometimes obseived that the fatal piognostics given 
in the eoiollaries 6 and 7, weie not veiified when the mattei made its way 
outwaids, 01 abscesses foimed in paits less essential to life And this 
natural piocess has been often happily imitaded by the ancients, by eautei- 
ismg 01 otherwise incising, the affected paits 

SIXTH OBSERVATION 

OF CHRONIC DISEASES IN WHICH THE PRETERNATURAL 

SOUND IS OBSERVED 

XXVI 

The pi etei natural sound obseived in chionic diseases is owing eithei 
to (1) some hidden condition of the organs, which disoideis them vnth a 
slow progress and finally destroys them, or exists (2) when ceitain obvious 
causes have induced a slow disorganisation of the same 

[2001 



Schohum These aie the general sonices of chrome diseases of the 
chest, and from whiehevei of the two classes of causes these arise, the 
morbid sound will equally and always be present 

‘XXVll 

The diseases of the first class are, (1) those which depend on hereditary 
piedisposition, (2) those which aiise fiom affections of the mind, par- 
ticularly ungratified desires, the principal of which is Nostalgia, (3) 
those which affect ceitain artisans, natuially possessing weak lungs 
Schohum 1 The influence of an hereditary taint in producing diseases 
we know by experience, though we cannot explain it — See Van Swieten 
2 Mental affections, we find, produce quite opposite effects, while acting 
as causes of pectoral diseases Of these affections of the mind I have ob- 
served none more poweiful in rendering obscure the natural resonance 
of the chest, than the destruction of cherished hopes And as among this 
class of diseases. Nostalgia (commonly called Immivehe — home ail) occupies 
the first place, I shall heie give a short history of it 
When young men, not yet arrived at their full growth, are forcibly im- 
piessed mto the military service, and thereby at once lose all hope of re- 
turning safe and sound to their beloved home and country, they become 
sad, silent, listless, solitary, musing and full of sighs and moans, and 
finally quite regaidless of, and indiffeient to, all the cares and duties of 
hfe Prom this state of mental disorder nothing can rouse them, — ^neither 
argument, noi promises, noi the dread of punishment, and the body 
gradually pines and wastes away, under the piessuie of ungratified desires, 
and with the pretei natural sound of one side of the chest This is the 
disease Nostalgia I have examined the bodies of many youths who have 
fallen victims to it, and have uniformly found the lungs fiimly united to 
the pleura, and the lobes on that side whei e the obscure sound had existed, 
callous, indurated, and more oi less puiulent Some yeais ago, this disease 
was veiy common, but is now rarely met with, since the wise arrangement 
has been adopted of bmiting the period to militaiy service to a certain 
number of yeais only 

3 The various arts and occupations of life have then peculiar diseases, 
in like mannei as the ages, tempei aments, and sexes have theiis This 
truth is exemplified in the ease of the man of letters, the husbandman, the 
workers in metals, painters, etc , etc Our particular business, however, at 
present, rs with those arts which dispose to diseases of the chest indicated 
by the sound so often described Thus I have remarked that Tailors, 
Millers, etc who are forced to inhale, during then labouis, a fine dust, be- 
come phthisical, while shoemakers, veaveis, etc from the forced position 
or application of then veak chests, during their various occupations, be- 
come asthmatical, with scirrhous lungs, etc 

[2013 



1 may here state a fact which I have fiequeiitly proved by dissection, 
but which I cannot well account foi — it is this in the above mentioned 
class of cases it is extiemely laie to find both lungs affected at the same 
time, and, when this happens, one lung is always moie diseased than the 
other 

XXVIII 

The diseases mentioned (in XXVI, 2) aiise eithei fiom (1) a vitiated 
condition of the fluids, giadually piodueed, oi (2) fiom acute affections 
impel feetly cured 

SclwUxim 1 The vitiation of the humouis aiises fiom ingesta which 
cannot be assimilated, the effect of which in pioduciiig chionic diseases is 
well known 

2 An acute disease is said to be impeifeetly cuied when some morbid 
affection stiU lemains aftei it, in some pait of the body This nioibid 
condition will be obseived eitliei in the site of the piimaiy disease, oi, 
at least, in that poition of the chest, which yields the nioibid sound, — 
namely, the pleuia, oi lungs, oi both these togethei, oi the mediastinum or 
peiicaidium When the piimaiy inflanimatoi}'- disease is succeeded by a 
collection of pus in the chest, the affection is leadily lecognized, but if 
the secondaiy affection is a seiiihus of the lung, how often and how 
grievouslj'’ aie medical men theieby deceived* Often have I met with 
cases of fancied convalescence fiom acute feveis, in which there was haidly 
any cough or dyspnoea, oi indeed any othei sign of disease (as appeared 
to the attendants) but a trifling degiee of iiiegulai fevei In these cases, 
howevei, on peicussioii the pieteiiiatuial sound was found over one whole 
side of the chest, and the final lesult was death, pieceded either by dropsy 
or extreme emaciation, the leal seat of the disease lemaimng, perhaps, 
unloioivn to the very last ' 

XXDC 

For the above leasons, it may be lecen'^ed as a geneial lule in chionic 
diseases, that when, togethei with the indication stated XXVI, theie are 
emaciation and debility, — the ease is desperate 

SchoMim This result is inevitable whensoevei the disease does not yield 
to medicine In such cases we may always conclude, that the lung of the 
side which yields the preternatural sound, is either eompiessed by some 
foieign body, is induiated by disease, oi destroyed by some morbid 
aeiimony developed within its own stiueture 


[ 202 ] 



SEVENTH OBSERVATION 

OF THE PRETERNATURAL SOUND OF THE CHEST WHICH 
RESULTS FROM COPIOUS EXTRAVASATION OF THE FLUIDS 
CONTAINED IN THE VESSELS OF THAT CAVITY 

XXX 

The fluids contained m the vessel of the chest are 1 Chyle, 2 Blood, 
3 Serum and Ljunph 

Scholtum I must candidly admit that I have nevei seen a case of 
extra vasated chyle I hmvevei believe the thing possible, although I am 
well aware that the thoiacic duct runs outside the pleuia the same causes 
that produce erosion and perforation of the thoiaeic parietes, may pioduce 
this 

XXXI 

The extravasation of these fluids (XXX) may aiise from the following 
causes (1) ruptuie of the containing vessels, (2) too gieat tenuity of the 
contained fluids, (3) nonabsoiption of the same, etc, etc 
ScJiohum 1 Under this head come wounds, contusions, etc 

2 Extravasations from internal causes aiise fiom rupture of relaxed 
and debilitated vessels, dining a state of plethora and ovei activity of the 
circulation 

3 A third class of causes aie obstructions oiiginating in a bad habit of 
body 

XXXII 

When from these causes the fluids mentioned aie pouied out in con- 
siderable quantity, the preternatuial sound will exist over the space oc- 
cupied by them 

Sclwlmm The correctness of this statement is evinced by the expeii- 
ment mentioned at the end of the scholium of X\^II 
Aecoiding to the plan foimeily pioposed (XI), I shall now pioceed to 
notice those affections of the chest which are not indicated by pel mission 

EIQHTH OBSERVATION 

OF THOSE AFFECTIONS OF THE CHEST WHICH ARE 
NOT INDICATED BY PERCUSSION 

XXXIII 

Celt am diseases attended by a violent cough, and thereby ci eating a 
suspicion that the lungs aie ceitainly implicated, are neieitheless tiuly 
diseases of the abdomen, and affect the pulmonaiy oigans merely smi- 
pathetically 


[ 20^3 



Scholium Under this head are ranged the gastric and convulsive coughs 
of infants, piegnant women, and such other persons as have their ah- 
dominal viscera oppiessed by the lentoi of autumnal agues, or a superfluity 
of phlegm 

XXXIV 

Violent coughs, dyspnoeas, asthmas and consumptions, aie also occa- 
sionally obseived which oiiginate in some ineompiehensible nritability of 
the nerves of the chest 

Affections of this soit laiely give use to the pi etei natural sound from 
the absence of this, howevei, and the piesence of a copious watery urine, 
their existence may be pietty confldently piesumed 

Scholium Undei this head aie langed the coughs, dyspnoeas, and 
asthmas so common in hysteiieal and hypochondiiacal affections, the 
neivous consumption and asthma of old peisons, and, perhaps we may 
add the poljTious coiicietions found ncai the heait m voung subjects 

XXXV 

A slight engoigemcnt of the lung, a sen i bus of small extent, a small 
vomica, and a tiifling extiavasation, aie not detected by percussion, — 
unless, sometimes, by tlie deei eased lesonanee of the affected pait 

Scholium These affections aie not dangeious until they reach a size 
when they become moie leadily diseoyeiable by means of percussion 

XXXVI 

Theie is aiiothei class of diseases of the lungs fundiscoveiable b}’' pei- 
cussion] in which the distinguishing symptoms aie a veiy seyeie cough. 
With expectoiation of fatty, challn'-, gypseous and stony matteis 

Scholium The cases aie known by the natuie of the expectoiation I 
haye frequently obseiyed a cough of this land (but without the peculiai 
expectoiation) succeeding miliaiy feveis impiopeily treated 

NINTH OBSERVATION 

OF THE APPEARANCES ON DISSECTION, IN CASES WHERE 
THE PRETERNATURAL SOUND OF THE CHEST 
HAD BEEN OBSERVED 

XXXVII 

These aie the following 

1 Scirrhus of the lungs , 

2 The conversion of this into an ichorous vomica, 

3 A puiulent vomica (simple or luptured) in the pleuia, lungs, medias- 
tinum or perieaidium 

4 Empyema, 

5 Dropsy of the chest, in one oi both cavities, 

[ 204 1 



6 Dropsy of tlie pericardram , 

7 Extensive extravasation of blood in the cavity of the pleura or peri- 
cardium , 

8 Aneurism of the heart 

SchoUiim I will now pioeeed to notice these diseases in older, premising, 
occasionally, some account of the general symptoms 

TENTH OBSERVATION 

OF SCIRRHUS OF THE LUNQS, AND ITS SYMPTOMS 

XXXVIII 

By sciiihus of the lungs I mean the degeneiation of the natural spongy 
substance of the oigan into an indolent fleshy mass 
Schohuvi A poition of sound lung swims in water, but this cainifoim 
degeneiation sinks There is often observed a vast diffeience in the char- 
acter of these scirrhi, in lespect of haidness, colour, and component parts 
Thus, in inflammatorj’- diseases of the chest pioving fatal on the fifth, 
seventh, oi ninth day, the lung is veiy often found so completely gorged 
with blood, as to lesembie livei in evei}^ respect, both as to colour and con- 
sistence One appearance deserves to be noticed the lung is fiequently 
invested with a puiulent adventitious membiane, in those instances where- 
in the fatal peiipneumony has succeeded an acute pleurisy In chionic 
diseases of the lungs the appeal ances aie extiemely vaiious Fiequently 
they are inteispersed and as it weie maibled with a fatty kind of mattei , 
fiequently along with the fleshy appearance, they have the consistence 
of caitilage, and very often they aie found mduiated by means of a 
thickened and black blood These varieties, doubtless, depend on vaiieties 
of the morbific matter 

xx:x;ix 

The piesenee of sciirhus of the lungs, ui its piimary unsoftened condi- 
tion, may be suspected fiom the following signs 
Together with the diminution or entiie loss of the natuial sound ovei 
the affected pait, theie is an infiequent cough without any expectoration, 
01 with only a scanty exeietion of viscid and ciude sputa During a state 
of quiescence theie is nothing to be observed much amiss, either in the 
condition of the pulse oi lespiration, but upon any considerable bodily 
motion, or after speaking for some time, these persons become speedily 
exhausted, anxious, and bieathless, and complain of a sense of diyness and 
loughiiess in the throat At the same time the pulse, which had previously 
been of moderate fiequencj^, becomes quick and unequal, the respiration 
and speech are bioken and inteiiupted by siglis, the temporal, sublingual, 
and 3ugulai veins of the affected side, are more than usualty distended, 
vhile it will be obseiied that tins side of the chest is less moi cable than 

[205] 



the othei, dining inspnation Meanwhile the natuial and animal functions 
continue to be well pei formed, and the patient can he on eithei side in- 
diffei ently 

All the above symptoms aie moie seveie in piopoition as the sciiihus is 
moie extensive 


ELEVENTH OBSERVATION 
OF VOMICAE IN QENERAL 

XL 

When an hiimoiii, sound oi inoihid, is deposited fiom the ciieulating 
mass in a solid foim, and (togethei with the extieme lessels) is aftei- 
waids, by means of tlie iital powcis softened and conveited into matter, 
and contained in a soil of capsule, I teim this collection of mattei a 
Vomica 

Scholmin This notion applies to eveiy %omica, whethei pioduced by a 
vice of the solids oi fluids, as is cleai fiom the histoiy of obstiuction and 
inflammation 

XLl 

I have obseived two kinds of Vomica — the Ichoions and Puiulent The 
foimei occupies the lungs only, the lattei, both the lungs and othei thoiacic 
visceia They aie both eithei close, oi communicating vith the Tiachaea 

Scholium Bj’’ the teim lehoioiis Vomica, I mean a sac containing a thin 
fluid fiequontly of a i eddish yellow coloui, fiequently of a i eddish biovn, 
often of a coloui between these, diffeieiit fiom pus, and aiising fiom the 
destiuction of a sciiihiis lung By Puiulent Vomica, I undeistand an 
encysted abscess of the chest, lesulting fiom the comeision of an inflamed 
spot into a white, thick, glutinous, fatty mattei When these communicate 
with the Bionchia and dischaige aiiv of then contents by expectoration, 
they are called open, othei wise, close oi shut 

XLII 

1 lehoious Vomica — If a sciiihus of the lung, lecognized by its piopei 
signs (XXXIX) IS conveited into mattei, it piesents the following symp- 
toms The patient begins to languish and Avaste away insensibly (although 
the usual quantity of food is taken), ivith a quick, conti acted, and unequal 
pulse The lespiiation, even duiing a state of quietude, is unnatuiallv 
anxious and fiequent, and is leinaikably inteiiupted by sighing The 
foiehead, during the moie sei^eie attacks, is sometimes coveied with a cold 
sweat The eyes aie dim, the imms of the cheelvs and lips aie Imd, and 
the tongue, esxieeially on the affected side, is of a leaden hue At the same 
time theie is iieithei pain noi thiist The diseased side, howei’^ei, is oh- 
seived to be less mobile than natuial, and the degiee of immohilitA^ is 
piopoitioned to the hulk of the vomica into which the sciiihus has been 

[ 206 ] 



resolved The cough is mfiequeiit, inter lupted, and diy, oi the expectora- 
tion, if any, is duty or blackish (eoenosuin aut fuscum) 

When things have got to this height, the appetite begins to fail, and at 
length IS entirely lost, and whatever is eaten only produces an increase of 
anxiety during the process of digestion this process however, takes place 
without any hectic flushing, which always accompanies the purulent vomica 
In some cases, when there is a dissolution of the central parts of the 
senihus, the abdomen and hypoehondies sink m, in a very few instances, 
the same parts aie slightly swollen, and with an indistinct feeling of 
fluctuation The urine rarely presents any deviation from the natuial 
state, sometimes, however, it is red, and with a sediment (if any exists) 
of a cinnabar colour The stools are of natural character, except under 
the mflueiice of medicine The extremities, even when of a livid eoloui, 
are never hotter than natural, until a few days before death, the affected 
side IS, moreover, observed to swell, and the hand and foot in the first 
place The patient now suffers from fiequent sinkings and faintings, 
and from having hitherto been able to lie easily on either side, he is able 
to remain on the affected side only 

2 Close Purulent Vomica — The following are the symptoms of this 
affection While the abdominal organs still continue to peiform then 
functions well, there is often present a very troublesome, frequent, dry 
cough, so severe as to nutate the fauces, to render the voice hoarse, and 
often to excite vomiting At this time are observed frequent iiregulai 
chills, followed by heat, and strong flushing of the cheeks and lips, pai- 
tieulailj'’ of the affected side A degree of lassitude is experienced, more 
remarkable after a full meal, and at the same time there is perceived a 
degree of quickness and stiaitness of the respiration, sufficient to excite 
suspicion of some morbid affection of the chest The pulse is also found 
to be contracted, fiequent somewhat haid and unequal during the period 
of digestion, and even at othei times it is never in a perfeetl 5 '' natuial 
state, — more especially under the influence of bodil}'’ motions, laughing, 
01 speaking 

If at this time the Vomica has reached a size to be detected bj’' percus- 
sion, the following additional signs exist The patient is not nourished 
by the food taken, partly because it is, in a greater or less degree, re- 
jected by lomiting, and partly on account of the imperfect assimilation 
of what IS retained As the disease increases, the whole process of 
lespnation is at length earned on by one lung, an incessant state of 
anxiety prevails, and the patient remains fixed on the diseased side, 
tliiough diead of impending suffocation if he turn on the other The 
face, hands, feet, and the affected side are oedematous, vhile the op- 
posite side of the body, from deficient assimilation, hectic heat, and 
iioctuinal peispiiations, is extenuated The uime now becomes scanty, 
led till bid, -with a copious biannv sediment and soon piitiefies, and the 

[ 207 ] 



scene is finally closed, witli shoit and asthmatic bi eathlessness, lividity 
of the cheeks, lips, and nails, etc 

3 Purulent Vomica communicating with the Tiachea — When a Vomica 
of considerable size, discoveiable by peicussion, buists into the Tiachea, 
or latliei Bionchia, by a laige opening, it pioduces instant sufCocation, 
if by a small apeituie, it is leeognized by the following maiks By 
means of a violent cough, pus is expectoiated, Avhich is, in diffeient 
cases, white, yellow, safEion, gieeii, blown, bloody, which sinks in watei, 
and, when thrown on hot coals, emits a stinking nidoious smell If at 
this time, while the patient is coughing and spitting, the pahn of the 
hand be placed ovei the site of the vomica, i e ovei the place wheie 
its existence had been detected by peicussion, — the noise of fluid within 
the chest will be sufficiently manifest This kind of expectoiation wiU 
cease foi some days, with lelief to the patient, but it speedily letuins, 
and is always pieceded, foi foui and twenty houis, by an inciease of 
the febiile state Dining this state of things, and befoie the letuin 
of the expectoiation, if peicussion is applied ovei tlie site of the vomica 
a sound exactlj^ like that fiom a fleshy limb is obtained, but if this is 
delayed until the evacuation of the accumulated pus, then theie is pei- 
ceived a distinct, tliough obtuse sound The slow feiei which invaiiably 
accompanies this condition, is enci eased aftei eating, and is still higliei 
duiing the night, and at these times, the foiehead, neck, and chest, aie 
covered with peispiiation With the inciease of these symptoms, and 
the continuation of the puiulent expectoiation, the bieath becomes 
tainted, insomuch as to be extiemely disagieeable both to the patient and 
the attendants The tliiist continues gieat, but the appetite is lost, even 
foi the gieatest delicacies, which, howevei spaiingly taken, pioduce, in 
place of 1 efi eshment, langoui and anxiety (The case is veiy diffeient 
with them whose sputa aie inodoious, the appetite in many being even 
great ) The uiine is uiiifoimly fiothy, glows speedilj”^ putiid, and de- 
posits a viscid, tenacious, ivliite sediment The patient now daily giows 
moie emaciated the bones almost pieice the skin, the han falls off, 
the nails become cuived, the legs swell, at length a colliquative diaiihaea 
supeivenmg fiist lessens, and then supiii esses the expectoiation, and the 
sufferei finally dies suddenly, on the thud day aftei that on which he 
began to leinain obstinately fixed on his back, with his legs diawn undei 
him 

XLIII 

Empyema — When a vomica (XXXVII), ascei tamed by peicussion, dis- 
charges Its contents into the cavity of the pleuia, and upon the diaphiagm. 
Empyema is piodueed 

Bchohum I piemise this definition to pi event the affection now in ques- 
tion from being confounded with a vomica that has dischaiged its contents 
into the tiachaea 


[ 208 3 



XLIV 

If a laige vomica, wliose superficial and. cential extent is supposed to 
have been recognized by the marks pointed out (Obs Thud XV, XVI, 
XVII), shall have buist as above mentioned (XLIII), it may be recognized 
by the following signs 

The patient who had usually lam on the affected side, staits up with a 
sudden pain (as if neaily suffocated), and begs to be held in the erect 
posture 

If percussion is now applied, it will be found that the natural sound, 
which had been nearly lost in the site of the vomica, has in some degree 
been restored in that place, while it is more or less destroyed (according 
to the quantity of pus effused) ovei the posterior and inferior parts of the 
chest 

There is nmv a very fiequent cough, ivluch is either dry, or with a scanty, 
frothy and noisy expectoration The respiration becomes very laborious, 
with fiequent faintings, and a cold sweat bedews the forehead and throat, 
the cheeks and lips are of an ominous red, while the nails grow livid, the 
pupils dilate, and death (which follows in a few hours the rupture of a 
large vomica) is finally preceded by dimness of sight, etc 
A small vomica, luptuied in the same manner, produces the same sjonp- 
toms, and is equally fatal This issue, however, is of later occur lence, and 
IS preceded by the marks of pleuio-peripneumony 

TWELFTH OBSERVATION 
OF DROPSY OF THE CHEST 
XLV 

When watei is collected in the cavity of the chest, between the pleura 
(costalls) and the lungs, the disease is called diopsj’ of the chest, and this 
IS said to be of two kinds, namely, according as the fluid occupies one, oi 
both sides 

Schohxim This is ascertained by percussion in the living subject, and is 
demonstiated by anatomical examination after deatli The geneial sjmip- 
toms of this disease aie chiefly the following 

1 Difficult and laborious lespiration, 

2 A cough at inteivals, vhieh is dry, oi only attended lyy sputa of a 
thin vateiy nature, oi occasionallv somewhat viscid, 

3 A pulse contiaeted, sonievliat hard, fiequent, unequal and often intei- 
mitting, 

4 A sense of bieathlessness and suffocation on the slightest motion , 
0 An incipient dislike of vaim food, 

6 Peipetual anxiety about the scrobieulus coidis 

[209 ] 



7 Gieat piessme on the chest, and distention of tlie stomach diirino 
the peiiod of digestion, 

S A miuiniumg noise about the liypochondies, and fiequent eiuctation 
of flatus, with momentaiy lelief , 

9 Scaicely any thiist, 

10 Uiine veiy scantjq and laiely made, led, with a lateiitious sediment, 

11 Swelling of the abdomen, inoic especially in the Epigastiium, and 
paiticulaily in that point on which the incumbent watei giavitates, 

12 A sublivid swelling of tlie c\<icniitics, espcciall}’- of the feet, which 
aie moieovei cold to touch , 

13 Oedematous tumescence of the infeiioi palpebiae, 

14 A pallid, 01 , aceoiding to the natuie of the affection, a sublivid 
diseoloiation of the cheeks, lips, and tongue, 

15 Inability to lie down, anxious distiessing nights, with heaviness, 
jmt fiequently sleepless 

All these sjnnptoms lai} in ,i wondeiful mannei aceoiding to the 
disease 

Fust Kind — Diopsj" of one side of the Chest Beside the geneial 
signs of this disease above enumeiatcd, the affected side, if completely 
filled with watei, is enfeebled (efloemiiiatum), and appeals less move- 
able duiing inspiiation In this case, also, the affected side yields no 
wheie the natuial sound on pcicussion If the chest is only half-filled, a 
loudei sound will be obtained, ovei the paits to which the fluid does not 
extend, and, in this case, the lesonance ivill be found to vaiy aceoiding 
to the position of the patient, and the consequent level which the liquid 
attains The Ilypochondie of the affected side is also unusually tumid, 
and moie lesisting to piessuie than the lest of the abdomen The 
palpebia, hand, and foot of the affected side aie slightly oedematous It 
IS a leniaikable fact, that the leclining postuie (decubitus declivis) is 
easily boine when the chest is entiiely full, while the contiaiy is the 
case, when theie lemains space foi the fluctuation of the wmtei 

Second Kind — Diopsy of both sides of the Chest If fluid is contained 
in both sides of the chest, the following specific signs, in addition to the 
geneial symptoms, exist The natuial sound is destioyed ovei the spaee 
occupied by the watei in eithei side The patients unifoimly become 
asthmatic, and resemble, in many lespects, those labouiing undei Ascites, 
only that the formei have then infeiioi palpebiae and hands swollen 
They cannot lie in an hoiizontal postuie, and aie equally thieatened 
with suffocation on whichevei side they tuin, on which account, they aie 
foiced to lemain sitting, day and night, to pi event the piessuie of the 
fluid fiom being felt on the uppei paits of the chest (which would be the 
ease on lying down), in the same degiee on which it now giavitates on 
the abdomen The effect of this state of things might lead to the siis- 

[ 210 ] 



picion of Ascites, oiiiy that we find, on examining the patient in the 
erect position, that the hypochondiiac legions aie moie sirolleii than the 
inferioi paits, which is not the case m Ascites 
All these subjects die as if fiom peripiieumony, that is to sa3%— the 
pulse fails, the whole body, except the chest and head, glows cold, the 
cheeks and extiemities become livid, the respiiation is at fust laboiions, 
then mteiiupted, and finally ceases altogethei 

XLVI 

Diopsy of the Peiicaidium — ^When the liquor peiieaidn is moibidly 
mcieased, so as to be capable of distuibmg the natuial action of the 
heart, the disease is called Diopsy of the Peiicaidmni of this theie aie 
two species, as the fluid is puiulent oi serous 
Scholiwn The fluid natuially piesent in the peiicaidium accumulates 
in still gieatei quantity in those who suffei a long proti acted moital agonv, 
as we find on examination after their death But it is not to this accumula- 
tion, oiiginating in the lelaxation of death, but to that pioduced by ob- 
stiuction dining life, that I apply the term diopsy I have ventuied to 
divide the affection into two species, because I have often witnessed both 
of them In the fiist variety, the heart is lougli, and as it were shagged, 
with a coating of the puiulent inattei , while in the latter, the oigan is 
only of a palei colour than iiatuial Many may be of the opinion that the 
puiulent diopsy would be bettei classed undei the head of Empyema, but 
I shall nevei qiiaiiel about words, when there are appearances to instinct 
us 

Signs of Hydiopeiicaidium — Almost all the symptoms which have al- 
leady been eniimeiated as accompanying diopsy of the chest generally, 
accompany this species also in addition to these, however, I have observed 
the following specific signs of the diopsy of the peiicaidium — 

The sound in the cardiac region, which I have already stated (III 
2, 3) to be natuiallj^ more obscure than in the otliei parts of the chest, 
is now as completely deadened as if the peicussioii were applied to a 
fleshy limb A sw^elling is peiceived m the piaeeordia, rvhieh can leadilv 
be distinguished, by its super loi resistance, fioni the stomach distended 
by flatus 

The patients fall asleep, while sitting, the body being inclined foiwaids, 
but they soon are roused bv the unconscious dropping of the head On 
this account, thev complain to all aiound them of the distressing pro- 
pensity to sleep which they expeiience At the same time ther suffei fiom 
laintings (accompanied by a pulse fiequently unequal in lesjieet both of 
Us ivthm and rolume), and, indeed continue to undei go to the end ol 
then wretched life, and in eveiv position of bodv, the greatest distress A 
few dars hefoie death, in many cases the neck is swollen and the eres 

[ 211 ] 



become extremely led, as if fiom crying This state of things is sometimes 
terminated suddenly by a stioke of apoplexy, or moie slowly by leipo- 
thymia 

The same signs aie furnished by percussion in the purulent, as in the 
pioper diopsy of the peiicaidium, but in the foimer, the other symptoms 
are piecisely the same as those which exist in the close puiulent vomica 
In the puiulent dropsy, the fluid commonly lesembles turbid whey,— the 
thickei poitions of it (quod puiulentum est) being found adheiing to the 
heart like fringes 


THIRTEENTH OBSERVATION 

OF THE SYMPTOMS OF A COPIOUS EXTRAVASATION OF BLOOD 

XLVII 

The causes of a laige extiavasation of blood into the cavity of the chest 
have been noticed in the Scholium of XXXI The following aie the symp- 
toms of this affection 

Scholium Theie is incessant and indeseiibable anxiety and oppiession 
at the piaecoidia and on the chest, wliile theie is constant jactitation of 
the body, and complete intoleiance of the hoiizontal postuie Peicussion 
elicits none of the natuial sound ovei the space occupied by the extiava- 
sated blood lii all cases the pulse is extiemely con ti acted, fiequent, and 
iiiegulai in eveiy way The lespiiation is extiemely laborious, vuth a 
fiequent cough, and bioken by profound sighing All the veins become 
flaccid, and the eyes aie at flist led but ultimately pale Cold sweats etc 
follow, and the patient dies steitoious 

These aie the symptoms when the blood flows into the cavity of the 
pleura without aiij^ accompanjung lesion of the lungs when these are 
wounded, theie is also bloody expectoiation, and a passage of an to and 
from the wound in the paiietes of the chest 

FOURTEENTH OBSERVATION 
OF ANEURISM OF THE HEART 
XLVIII 

When the heart becomes so much distended by blood, accumulated in its 
auricles and ventiicles, as to be unequal to piopel foiward its contents, 
it fiequently becomes thereby enoimously dilated This dilatation has been 
called Aneurism of the Heait 

Scholium We fiequently obseive this state of the heart on dissection, 
(1) in sudden and extensive peiipneumonies of both lobes at the same 
time, and (2) in those fatal inflammatoiy diseases which are noticed to- 
wards the end of the Scholium on XXII 

[ 212 ] 



The pathognomonic sign of this affection is the complete fleshy sound on 
percussion existing over a consideiable space in the region of the heait 
Whenever this sound is peiceptible in the acute peripneuiiioiiy it is a sign 
that the patient mil not survive tiventy-four hours in fact, he is already 
at the last gasp, and is speedity earned off as m apoplexy, unconscious of 
his fate 

In the second class of inflammations, the sign is equally fatal, but is 
attended by different symptoms In tins case, the patients suffer diead- 
full anxiety and by the constant jactitation of then limbs, aie perpetually 
uncovering themselves Older persons, indeed bear more tranquilly their 
sufferings, but the younger aie pertinaciously restless and violent, strug- 
gling and taflmig, attempting to get out of bed, demanding their clothes, 
and endeavour ing to walk or go about their usual occupations Meanwhile 
the eyes become dull, the cheeks livid, and the nails and extremities are 
tinged with a leaden hue, and death is ushered in by cold sweats, and the 
gradual extinction of the pulse and respiration 

Cedant haec vusens in solatium, veils autem medicinae cultonbus in 
incrementum artis Quod opto' 


[ 213 ] 




1772 

HEBerde^ 

P,croK.s 




WILLIAM HEBEEDBN 

Portrait Tiy Sir William Beechey, R A , in the Royal College of Physicians, London 


(Courtesy Charles C Thomas) 



WILLIAM HEBERDEN 

( 1710 - 1801 ) 

“Good readers are almost as rare as good authors ” 

— ^William Heberden 

TIRING tbe Eigbteentli Century, which was characterized in medical history as 
JL) an age of theories and mdividual systems, few medical men were outstandmg 
Except for the original contributions of such men as Morgagni, Hales, John and 
William Hunter, Kaspar Enedrich Wolff, and Jenner, as Garrison has shown (p 310), 
the century represented a period of retrogression Too few physicians were prac- 
ticing bedside medicme, and the ideas which Harvey, Bacon, and Newton had put 
forth during the preceding century had not fired the general practitioners with en- 
thusiasm One of the reasons, other than his singular accomplishments, why William 
Heberden is given a conspicuous place in medical history is that he made it a point 
to battle the dogma and tyrannic ideologies of many of his contemporaries who were 
still wranglmg over the medical interpretations of the ancient writers Moreover, 
m his medical practice, which was very extensive, Heberden had the modern attitude 
of first studymg the patient as an mdividual and later relegatmg his illness or dis- 
ease to its proper place m the classification of disease 

William Heberden was born in London He was next to the youngest son of 
Richard and Elizabeth Cooper Heberden His preliminary education was obtained 
at the Grammar School of St Saviour, Southwark He entered St John’s College, 
Cambridge, m 1724: In 1728 he was granted the degree of Bachelor of Arts Two 
years later he obtained a fellowship in the same college In 1732 he received the de- 
gree of Master of Arts From that year on, he seems to have directed his attention 
to medical studies, and he received his degree of Doctor of Medicine in 1739 
Dunng his stay in medical school and while he was studymg materia medica, 
Heberden was engaged m writing “An Essay on Mithridatium and Thenaca “ In 
that work he exposed the use of mithridatics as antidotes for poisons, so that these 
glamorous drugs thereby lost their importance The work was not published until 
1745 It IS of mterest m the present accoimt to note Heberden ’s broad acq,uamtance 
with the classics Not only did he call on Hippocrates to elucidate some points, 
but he also quoted from Homer, Plautus, Virgil, Juvenal, and others 

In 1746 Heberden was elected a fellow of the Royal College of Physicians, and 
in 1748 he began the practice of medicine m London Heberden was further hon- 
ored m 1749 when he was elected a fellow of the Royal Society Some of his most 
valuable contributions to medicme subsequently were published m the “Philosoph- 
ical Transactions’ ’ of the Royal Society 

In 1752 Heberden marned Elizabeth Martin, daughter of John Martm, a promment 
citizen and a member of Parliament His wife died m 1754, leavmg inm -with two 
sons John, who died m mfancy, and Thomas, father of the well-known physician, 
Thomas Heberden In 1760 William Heberden married again, this time to Mary 
Wollaston By his second marriage he had eight children, only two of whom sur- 
vived their father These were hlary and William, the latter of whom later became 
physician to the Kmg 


[ 217 ] 



Heljerden, in his practice of medicine, stressed the importance of expenence m 
the study and treatment of disease He makes this interesting comment, ‘ ‘ the 
practice of physic has been more improved hy the casual experiments of illiterate 
nations, and the rash ones of vagabond quacks, than by the reasonings of all the 
once celebrated professors of it, and theoretic teachers in the several schools of 
Europe very few of whom have furnished us with one new medicme, or have taught 
us better to use our old ones, or have in any one instance at all improved the art of 
curing diseases”! 


rrom all published accounts it seems that both Heberden’s professional and 
social contacts were pleasant He treated William Cowper and Bishop Warburton, 
but perhaps his most famous patient was Samuel Johnson, whom he attended in his 
final illness Johnson, in the codicil to his will, left Heberden one of his books 
According to a note by Nichols in Boswell’s ‘‘Life of Samuel Johnson,”^ Dr Johnson 
once called Heberden, ‘‘Dr Heberden, ultunum Eomanonim, the last of our learned 
physicians ” Among Heberden’s friends and colleagues were John and William 
Hunter, Fothergill, Jenner, Sir George Baker, Withering, Pitcaim, and Eobert Gooch 
He also was acquainted with Benjamin Franklin, who induced him to publish for 
the American colonies a most interesting pamphlet,! giving instructions for inocu- 
lation for the prevention of the smallpox (1759) According to Pettigrew, Heberden 
was also on intimate terms with the chief literary men of his day, among them Gray, 
Jacob Bryant, Mason, Cavendish, Bishop Hurd, Bishop Lowth, Dr Kenmcott, Dr 
Jortm, Tyrwhitt, and Stuart Heberden himself translated the plays of Eiinpides 

George III thought well of Heberden and, upon Queen Charlotte’s arrival in Eng 
land in 1761, he was named physician to her, an honor which he declined because 
he felt it might interfere with life as he wished to live it 

In 1778 Heberden was elected an honorary member of the Eoyal Society of Medi- 
cine of Paris He retired from the practice of medicine in 1782 His last paper, 
‘‘Of the Measles,” was read at the College of Physicians in 1785 In 1787, being 
still rather active, he was elected vice-president of the Eoyal Humane Society He 
had retired years ago, of course, from active practice and, as he declares m his 
preface to the ‘‘Commentaries,” a preface which because of its beautiful sentiment 
and sage advice we have chosen to reprint in this book, he spent his last years in 
teaching what he knew to his sons Dr Heberden died in Pall Mall on May 17, 
1801, in his mnety-first year Included in LeEoy Crummer's prefatory essay to the 
publication of the Heberden manuscnpt, ‘‘An Introduction to the Study of Physic,” 
IS a list of Heberden’s published writings as well as a check list of Heberden’s 
manuscripts 

Heberden’s major opus was, of course, his ‘‘Commentaries on the History and 
Cure of Diseases,” published posthumously by his son, William The Eoyal College 
of Physicians owns the original two volumes of manuscript which Heberden had 
carefully written in Latin According to Crummer (p 11-12), each volume contains 
about the same material William Heberden, Jr, in 1802 chose to have published one 
of these volumes, which had been completed by the senior Heberden in 1782 The 
younger Heberden also translated the English edition of the ‘‘Commentaries,” 
published the same year (1802) There were many subsequent editions of the work in 
both languages, for it was one of the most popular books on medicine of the first part 
of the Nineteenth Century For those who are interested in the evolution of medical 


m Medical poitiait galleiy, London 1840 

\ KJl O i-'i-' XJ---*.*- 

The Life of Samuel Johnson, Bath England Geoige Bajntun 1925 


’Pettigrew Thomas J ‘IVilliani Heberden 
Whittaker and Co ^ol 3 pp 11-12 
"Boswell, James 
\ol 2 p 1013 

’Heberden William Plain insti iictions foj inoculation in the small-pox, hp which any 
nerson man he enabled to peifoiin the opeiation, and conduct the patient thiough the 
disteinpei Printed at the evpense of the author to be given a-naj in Ameiica London, 
1759, 12 pp 

[ 218 ] 



thought, this hook holds many fascinations In Heherden’s description of disease 
the keen, trained logical power of ohservation not surpassed hy Hippocrates or 
Sydenham is noticed The hook represents a careful analysis of the professional 
experience of more than forty years of active practice of a physician possessed of 
a high mental endowment In it are contained his original portrayals of varicella 
which he originally published in 1768,4 of angma pectoris, a condition which he 
named and which was first described hy him in 17725 which we are reproducing, and 
his notation of the nodules m the fingers which occur m arthritis deformans An 
actual case of angina pectons was described in the memoirs of the Earl of Clarendon 
( 1632)6 and Morgagni^ presented a description of this disease (1707) It is also 
of interest to note that at the same time Heherden reported his cases, Dr Eougnons 
of Besangon wrote a letter about it concerning a captain of cavalry who had d 
unexpectedly during an attack of pain situated in the retrosternal region The 
pain appeared after effort, similar attacks having occurred before Several other 
accounts of angma pectons were then reported, including Home’s account of John 
Hunter’s angma pectoris, which we are also reproducing But none was so clear and 
concise as the classic of Heherden, who not only gave the disease its name but also 
gave it a masterful description 


On the Chicken- Pov Med Tt Ko\ Coll llu!,, London 1 427- 


‘Htbculcn tlilliim 
1708 

iccouni of 1 di'^order of the breist Med Tr Ko^ Coll 

i u ' ixiudon iG-b I li72 

•Ci^c of Heni\ H\de 1G32 In ln>? L\fc Oxford 175<», p 9 

f ct cniisis morOoiiivi pci anaiomcn imlagatis hbri 

moduli in, ow!)ifirfir;sioHts, uuiic ptimum ciiifas complect uni ur p,opc- 
inortiim iHiiuiiuin^ iiKdicix cliiiiiiois anatomic;, profuUnas xol 1 p JS^ \enice itri 

f. ^ Lfffir a If font, toiwhnnt Ics cniiics'dc la moit d, 

iVgv -‘rpp «”<'»>' <r,p,tamc dc catnlcu, anme a ncaiuon Ic 2;7'\r,fr 

[ 230 ] 



COMMENTARIES 


ON 

THE HISTORY AND CURE 


or 

DISEASES 


BY 

WILLIAM HEBERDEN, M D 


r/fwv, xaVajA,<(vc5,Verj-^U'a^yo/,'7'ojA ra/3lC^^ov£yfa'^'^t, 
avyrd^Kf ras fctra ■>*{•>£?? sV 'J'wv iv^JKuiy virois 
KaraXrjfSeie’af kiI^ks- 

/LtX TRALL. Lib \U 


LONDON- 

TRlt^r^D TOR T PAYNE, MEWS-GATE, 

Bjr S Himiltoa, Falcon Court, F'cet Street 


1802 




COMMENTARIES ON THE HISTORY AND 
CURE OF DISEASES'" 

PREFACE 

P LUTAECH says,t that the life of a vestal viigm was dmded into thiee 
portions, 111 the fiist of which she learned the duties of hei profession, 
in the second she practised them, and in the thud she taught them to oth- 
eis This IS no bad model for the life of a physician and as I have now 
passed thiough the two fiist of these times, I am vnlling to employ the le- 
maindei of my days in teaching what I know to any of my sons who may 
choose the profession of physic, and to him I desiie that these papers ma}" 
be given 

The notes fiom which the following oliseivations weie collected, weie 
taken in the chambeis of the sick themselves, oi fiom then attendants, 
wheie several things might occasion the omission of some mateiial cnciim- 
stances These notes iveie lead ovei eveiy month, and such facts, as 
tended to thiow any light upon the histoiy of a distemper, or the effects 
of a remedy, were entered under the title of the distemper nr another book, 
from which weie extracted all the particulars here given relating to the 
nature and cure of diseases It appeared more advisable to give such facts 
only, as weie justified Iry the original papeis, however imperfect, than 
either to supply then defects from memory, except in a veiy few instances, 
or than to borrow any thing from other writers 
The collections from the notes, as well as the notes themselves, were 
written nr Latin, the distempers being ranged alphabetically, and tins is 
the reason that the titles are heie in tliat language In making the extracts 
it vas not only more easv to follow the order nr which the observations had 
been ranged, but there was likewise less danger of any confusion or omis- 
sion, and little or no inconvenience can arise from preserving the Latin 
names of the distempers 

An useful addition might hare been made to these papeis by comparing 
them with the ciiiient doctrine of diseases and remedies, as also vith 
what IS laid down m practical v liters, and with the accounts of those vho 
treat of the dissections of morbid bodies, but at my advanced age it vouid 
be to no purpose to think of such an undertaking 

V Oliam Cojimitnfai les on flic Sristory and Cure of Diseases, London, 
tPlutarch in XumS, et 


[ 221 ] 



CHAPTER 70 
PECTORIS DOLORS 

Beside the asthma, hj^steiic oppiessions, the acute daiting pains in 
pleuiisies, and the eluomcal ones in consinnptions, the hieast is often the 
seat of pains, Avhieli aic distiessing, soinctinies ei'cn fioin tlieii i^ehemenee, 
oftenei fiom then duialion, as they liaA’^e continued to tease the patient 
for SIX, foi eight, foi nine, and foi louileen leais Tlieie tiai^e been seveial 
examples of then letiuning peiiodiealh’' eveiy niglit, oi alternately ivitli 
a head-ach They have been called goutA, and ilieumatie, and spasmodic 
Theie has appealed no leasoii to .pidgc that thoA* pioeeed fiom aip’’ cause of 
much impoitance to healtli (being attended Avith no fcA^ei), oi that they 
lead to any dangeious consec|uenecs , and if tlic patient Aveie not uneasy 
AAutli Avhat he feels, he needs ncA'ci to be so on account of ain^ thing aaOucIi 
he has to feai 

If these pains should letuin at night, and disluib the sleep, small doses 
of opium liaA'e been found seiviceablc, and inaA be used alone, oi joined 
Avith an opening medicine, aaiIIi a piepaiation of antmionA’, oi AMth the 
fetid gums Exteinalh^ a small pcipetual blisfei applied to the hi east 
has been successtul, and so has an issue made in the thigh A laige cumin 
piaster has been Avoin ovei the scat of the jiain A\ith adi'antage The 
volatile, 01 saponaceous liniment, inaA be nibbed m ovei the part affected 
Bathing m the sea, oi in aiij' cold AA'atei, inaA be used at the same time 

But theie is a disoidei of the bicast maiked A\ith stiong and peculiai 
sj’mptoms, consideiable foi the kind of dangei belonging to it, and not 
extiemelA^ laie, Avhich desciA'os to be mentioned moie at length The seat 
of it, and sense of sti angling, and aiixictj’’ AVith aa'IucIi it is attended, mav 
make it not impiopeily be called angina pectoiis 

They aaIio are afflicted Avith it, aic seized Avhile thcA’’ aie Avalking, (nioie 
especially if it be up hill, and soon aftei eating) with a painful and most 
disagieeable sensation in the bieast, AV'hich seems as if it Aimuld extinguish 
life, if it Aveie to inciease oi to continue, but the moment they stand still, 
all this uneasiness vanishes 

In all othei lespects, the patients aie, at the beginning of this disoider, 
peifectly AA'^ell, and in paiticulai have no shoitness of bieatli, fiom aaIucIi 
it IS totally diffeient The pain is sometimes situated in the uppei pait, 
sometimes in the middle, sometimes at tlie bottom of the os steini, and often 
more inclined to the left than to the light side It likcAvise veiy fiequently 
extends from the bieast to the middle of the left aim Tlie pulse is, at least 
sometimes, not distuibed by this pain, as I have had oppoitunities of ob- 
serving by feeling the pulse duiing the paioxysm Males aie most liable 
to this disease, especially such as have past then fiftieth yeai 

‘Heberden’s original publication appeared m 1772 AA^e are reprinting fiom the Oom- 
mentaues published in 1802 — F A AA'^ 1940 

[ 222 ] 



Aftei it has continued a yeai oi inoie, it will not cease so instantaneonsly 
upon standing still, and it will come on not only when the peisons aie walk- 
ing, but when they aie lying down, especially if they lie on the left side, and 
olilige them to use up out of then beds In some inveterate cases it has 
lieen hi ought on by the motion of a hoise, oi a eaiiiage, and even by swal- 
lowing, coughing, going to stool, oi speaking, or any distuibaiice of mind 
Such IS the most usual appeal ance of this disease , but some vaiieties may 
lie met with Some have been seized while they weie standing still, or 
sitting, also upon fiist uaking out of sleep and the pain sometimes leaches 
to the light aim, as veil as to the left, and even down to the hands, 
but this IS uncommon in a vei}'^ few instances the aim has at the 
same time been numbed and swelled In one oi two peisons, the pain has 
lasted some houis, oi even days, but this has happened when the complaint 
has been of long standing, and thoioughly looted in the constitution once 
only the veiy first attack continued the whole night 
I have seen neaily a hmidied people undei this disoidei, of which 
number theie have been thiee women, and one boy twelve yeais old All 
the lest weie men iieai, or past the fittieth yeai of their age 
Peisons who have peiseveied in walking till the pain has letuined foui 
01 five times, have then sometimes vomited 
A man in the sixtieth yeai of his life liegan to feel, while he was walk- 
ing, an uneasy sensation in his left aim He nevei peicened it wliile he 
was tiavellmg in a carnage Aftei it continued ten yeais, it voiild come 
upon him two oi thiee times a veek at night, while he was in bed, and then 
he was obliged to sit up foi an houi oi two befoie it iiould aliate so much 
as to suftci him to be down In all other respects he was vein healthy, and 
had alvais lieen a lemaikalilv strong man Tlie breast was never af- 
fected This disorder, its seat excepted, perfectly resembled the angina 
pectoiis, giadually iiiei easing in the same manner, and being lioth excited 
and relieved by all the same causes He died suddenly vithoiit a groan at 
the age of seieiitv-fiie 

The teimination of the angina pectoris is lemaikalile For if no acci- 
dent inter 1 one, but the disease go on to its height, the patients all suddenly 
lall dovii, and peiish almost immediateh Ot winch indeed then fiecpient 
faintness, and sensations as it all the poweis ot life weie failing, aftoid no 
oliscnie intimation 

The angina pectoiis as tai as I ha\e been able to incestigate, belongs to 
the class of spasmodic not oi inflammatoic complaints Foi 
In the 1st place the access and the iccess of the fit is sudden 
2dlv, Theic aie loiur mtcnals of peifcct health 

3dh, 'Wnic. and spnitoiis lupiois and opium afioid consideiable lelief 
4thh It IS incicascd In distuibaiue oi the mind 
ithh It continues mam reals without am othei niiuin to the health 

[ 223 3 



6tlily, In the beginning it is not brought on by iiding on horseback, or 
in a carnage, as is usual in diseases arising from scirihus, oi inflammation 
Tthly, During the fit the pulse is not quickened 

Lastly, Its attaclcs aze often aftei the first sleep, which is a circumstance 
common to many spasmodic disoideis 
Yet it IS not to be denied that I have met with one oi two patients, who 
have told me they now and then spit up matter and blood, and that it 
seemed to them to come fiom the seat of the disease In another, who fell 
do\vn dead Avithout anj’' notice, tlieie immediately aiose such an offensive 
smell, as made all who weie piesent judge that some foul abscess had just 
been bioken 

On opening the body of one, who died suddenly of this disease, a veiy 
skilful anatomist could discovei no fault in the heait, in the valves, in the 
arteiies, oi neighbouiing veins, excepting small ludiments of ossification 
in the aoita The biaiii was likewise eveiy wheie sound In this peison, 
as it has happened to otheis who have died by the same disease, the blood 
continued fluid two oi thiec davs aflei death, not dividing itself into 
Cl assamentum and seium, but thick, like eieam Hence when a vein has 
been opened a little befoie death, oi peihaps soon aftei, the blood has 
continued to ooze out as long as the body lemained unbuiied 
With lespect to the tieatment of this complaint, I have little or nothing 
to advance noi indeed is it to be expected we should have made much 
piogiess in the cuie of a disease, which has hitlieito haidlj^ had a place, or 
a name in medical boolts ^ Quiet, alid waimth, and spnitous liquois help 
to restoie patients who aie neaily exhausted, and to dispel the effects of a 
fit when it does not soon go off Opium taken at bed-time will pi event the 
attaclis at night I know one who set himself a task of sawing wood foi 
half an houi eveiy day, and was neailj’' cuied In one also, the disoidei 
ceased of itself Bleeding, vomiting and puigiiig, appeal to me to be im- 
proper 


*Coelius Aurelianus, as far as I know, is the only ancient writei who has noticed this 
complaint, and he but slig-htly ‘Erasistratus memorat paralyseos genus et pmadoxon 
appellat, quo ambulantes repente sistuntur, ut ambulare non possint, et turn rursum am 
bulare sinuntur ” — Ohron lib ii c 1 — Saussure in his Yoyage dans les Alpes says, 
that at the height of 13 or 1,400 toises above the sea, a peculiar tiredness often comes 
upon those who are ascending such high hills, so that it is impossible to proceed fwr 
steps further and if it were attempted such strong universal palpitaUons would 
on Is could not fail to end in swooning Upon resting three minutes, even without 
sitting down, this tiredness passes, and the power of going on is perfectly restored The 
clSbing of steep hills, which are not so high above the sea, does not occasion this 
peculiar fatigue — ^Vol 1 P 482 

[m] 



AM 




1785 




The 




ove 


V 




I 


r 


WILLIAM WITHERING 

Painting "by Carl Frednk von Breda in the National Museum, Stockholm 




(Courtesy Dr Drew Luten ) 


WILLIAM WITHERING 

(1741-1799) 

“The Flowei of Physicians ’’ 

C^LTHOUGH Re was only fifty-eight years of age at the time of his death, 
Cyv William Withering lived an abundant life, and the period in which he lived 
was a most interesting one He saw the development of the steam engine, the use 
of gas lighting in Birmingham, the invention of the spinning jenny and the cotton 
gm It was his destiny to live through both the American and French Revolutions 
and to have been sympathetic with the citizen classes who fought for their freedom 
Moreover, he was a contemporary of such men as the elder Pitt, Burke, Samuel 
Johnson, Goldsmith, Robert Bums, Voltaire, Washington, Haydn, Beethoven, Mozart, 
Franklm, and Linnaeus 

William Withering was born at Wellington in Shropshire in 1741 Accordmg to 
Cushny, Withering’s father, Edmund Withering, was an apothecary, but it is ap- 
parent that the father practiced medicine i Withermg’s maternal uncle was a 
physician in Lichfield His mother’s father, Dr George Hector, had delivered Samuel 
Johnson Thus, early in life, William Withering made contact with the profession 
which was his eventual choice 

Withering was tutored privately at home by the Rev Henry Wood of Ercall 
Such a method of preliminary education was a common practice in the eighteenth 
century In 1762 he matriculated at the University of Edinburgh where he studied 
medicine Edinburgh was the residence of David Hume (1711-1776), the famous 
Scotch philosopher and political economist, who during Withering’s stay in this city 
was at the height of his bnlliant career Among Withermg’s professors were Hope in 
botany, Whytt (an authority on hysteria) in medicme, Alexander Monro “Secundus” 
(who in 1769 discovered the foramen of Monro) in anatomy, and Cullen m chem- 
istry and medicme Withering seems to have been on mtimate terms with the last- 
named professor William Cullen (1712-1790) held the chairs of medicine and chem- 
istry at both Glasgow and Edinburgh He was one of the first to give clinical lec- 
tures in Great Britain, and these lectures established a precedent in that they were 
delivered m English instead of m Latm Cullen was a source of great admiration 
and inspiration to his pupils and it is of interest to know that he supported Wither- 
ing in his therapeutic use of foxglove Cullen was the teacher of Benjamin Rush 
(1745-1813), and it was Rush who mtroduced mto America the complicated system 
of “fevers” as the basis for most diseases which Cullen had formulated and preached 
at Edmburgh Accordmg to Shryock, the mfluence of Cullen, as transmitted through 
the teachmgs of his pupil. Rush, had an effect on American clinical medicme that 
endured for a generation Withering received the degree of Doctor of Physic m 
1766, his thesis was “De Angma Gangraenosa” (malignant putnd sore throat) 
From 1767 until 1775 Withermg practiced medicme at Stafford It was here that 
he began studying the local flora and soon he became an expert in botany Dunng 
this time he was compilmg notes for his first book, “A Botaxucal Arrangement of 


’RoJdiq mO otliei biograplior^ sa^ tint he is a i>li\ sici in with a IiichU succ< =sful 
ITictico nt MolUngton 

[ 227 ] 




WILLIAM WITHERING RECEIVING FROM OLD MOTHER HTTTTON OF 
SHROPSHIRE THE RECIPE FOR HER HERB TEA WHICH HAD ‘ ‘RELIEVED 
AN OXFORD DEAN OF HIS DROPSY” 


(Courtesy Parke, Davis and Co ) 


(It will ke noted, on p 238 of tins work, that Withenng himself does not say that 
he actually visited or met this old lady, although he does mention Shropshire, and also 
Dr Cawley, of Oxford, who ‘‘had been cured of a Hydrops Pectoris” hy foxglove 
root ) 



all the Vegetables Naturally Growing in Great Bntain” (London, 1776, t 2) This 
was a masterful work and went through several editions The author not only gave 
a descnption of the plants but also indicated uses to which they might be put and 
often cited references made to them by the poets 

Withering was very popular in Stafford, and it seems that his latent interest in 
botany had been revived not because of his course in the subject under Hope, a 
course which had been disagreeable to him, but because of his labors in supplying 
suitable flowers for a young lady to paint The young lady was his patient, Helena 
Cook, whom he married in 1772 

Although he enjoyed his practice in Stafford and was the only physician at the 
county infirmary, the practice was a poor one, and counseled by Erasmus Darwin, 
Withering began the practice of medicme in Birmingham in 1775 At Birmingham, 
Withering found a congenial circle in the Lunar Society, of which the most eminent 
members were Joseph Priestley, the great chemist, and James Watt, who perfected 
the steam engine Withering was very successful in the practice of medicine and 
soon he was reputed to have the best practice outside of London He aided in the 
completion of the general hospital at Birmingham and at his own house on stated 
days he gave the poor free medical advice 

Withering’s extensive practice caused him to travel day and night While he 
traveled, he read and wrote On winter nights, to aid him in his studying, he had 
a light installed in his carriage In this manner he prepared his work, “An Ac- 
count of the Scarlet Fever and Sore Throat, or Scarlatina Anginosa” (London, 
1779) Withermg also interested himself in chemistry and m mmeralogy In 1783 
he translated a treatise by Bergman on mineralogy To Withering’s discovery of 
“Terra Ponderosa’’ (the natural barium carbonate), Werner, the German geologist, 
gave the name “Witherite ’’ In 1784 the Eoyal Society elected Withermg a fellow 
and in 1791 the Linnaean Society similarly honored him (Cushny, p 88) 

In 1785, Withenng published the little book, “An Account of the Foxglove,’’ 
which still has the greatest of interest to his profession and which, more than either 
his botanical or chemical work, entitles him to immortality In this superb 
monograph on the foxglove (from which we reprint the more important parts) 
Withering states that his attention was drawn to digitalis m 1775 by the discovery 
that it was important m the cure of dropsy This remedy was a decoction of herbs 
which an old woman m his native town, Shropshire, had compounded and used to 
cure the dropsy m instances in which qualified physicians had failed After care- 
fully analyzing the remedy, Withenng found the important ingredient to be fox- 
glove After experimenting with foxglove at great length and satisfying himself 
as to his results, he prescribed it in his personal dispensary Apparently, his interest 
was further stimulated by heanng that the drug had been employed successfully 
in the case of the prmcipal of Brasenose College, Oxford At first he made the leaves 
of the plant into a decoction, later mto an infusion, and sometimes he used the 
powdered form The use of digitalis quickly spread among Withenng’s fnends in the 
profession at Birmingham and Edinburgh In 1783 the drug made its appearance in 
the “Edinburgh Pharmacopoeia ’’ Erasmus Darwin, among others, used it (1785) 
and his son, Charles Darwin, the uncle of the great naturalist, also prescribed it at 
an early date 

On the basis of Withenng’s descnption of the patients he treated, it has been 
assumed that some of his patients suffered from auncular fibnllation But Withenng 
recommended the use of digitalis in dropsy and anasarca only, and was careful to 
state that it was valueless in the treatment of ovanan cysts and similar conditions 
His book was a curb on the unqualified uses of digitalis which grew out of the tre 
mendous populantv of the dnig Withenng did not understand how this dnig acted 

[229 ] 



in dropsy nor did he differentiate its action on cardiac dropsy from its action on 
other forms of dropsy At the same tune he was aware that it exerted some action 
on the heart and that it retarded the pulse, for he wrote, “That it has a power over 
the motion of the heart, to a degree yet unobserved in any other medicine, and that 
this power may be converted to salutary ends ’ ’ 

Besides enjoying a large circle of friends in Birmingham, Withering maintained 
connections with many of his profession in London His botanical work (ed 2, 
1787-1792) served to introduce him to many continental scientists, and the French 
botamst, L’Heritier de Brutelle, named a genus of plants Withermgia in his honor 

In politics Withering was a moderate progressive and held the viewpoint that 
the constitution under George III required some modifications In spite of this view- 
point and probably because he was sympathetic to the French revolutionists, Wither- 
ing’s house was attacked and he was forced to leave when the home of Fnestley 
was burned in 1791 by a mob He succeeded, however, in carrying off his most 
precious books and herbariums in wagons camouflaged with straw 

Withering suffered from tuberculosis of the lungs which finally undermined his 
health m 1780 Because of this, he chose to retire from active practice in 1783 
From 1790 to 1791 he had repeated attacks of pleunsy and from this time onward 
his strength declined In 1792 he spent the winter in Lisbon, Portugal, to try the 
effect of a warmer climate on his health At Lisbon he continued his botanical 
studies and also made an analysis of the waters of the springs at Caldas da Bamha 
Withering was not favorably impressed by the climate at Lisbon as a cure for phthisis 
and felt he had obtained little benefit from his stay He returned there, however, for 
the winter of 1793 

In 1794 his health grew worse, he had inflammatory pulmonary attacks, dyspnea, 
and repeated hemoptysis His health seemed to improve in 1795, so that he was able 
to publish in 1796 the third edition of his “Arrangement of British Plants,’’ this 
time expanded to four volumes From 1797 to 1798 his illness grew worse and he 
was so dyspneic that even writing was diflicult for him He died on October 6, 
1799, after twenty-five years of illness He was buried in the old church at Bdg- 
baston In this church is a monument inscribed in his name and encircled with 
the Withermgia and the purple foxglove of which he wrote 


[ 230 ] 



A N 


account 

OF THE 

FOXGLOVE, 

AND 

Some of its Medical Ufes : 

WITH 

PRACTICAL REMARKS ON DROPSY, 
AND OTHER DISEASES 


B y 

WILLIAM WITHERING, M D. 

Phjfician to the General Holpital at Birmingham, 


nonumque ptemalur in annum. 

Horace, 


BIRMINGHAM PRINTED BY M SWINNEY . 

FOP 

C G J AND J Robixsov Paternoster -Row, London 


M,DCC,LXXXV. 



AN ACCOUNT OF THE FOXGLOVE-^ 

PREFACE 

A fter being fiequentlj’’ niged to wiite upon this subject, and as 
often declining to do it, fiom appi eliension of my own inability, 
I am at length eomiielled to take up tlie pen, howevei unqualified I may 
still feel myself for the task 

The use of the Poxgloie is getting abioad, and it is better the world 
should deine some instuictioii, liowevei impeifeet, fiom my expeiienee, 
than that the lives of men should be hazaided by its unguaided ex- 
hibition, or that a medicine of so mueJi efficacy should be condemned 
and 1 ejected as dangeious and unmanageable 
It is now ten jmais since I fiist began to use this medicine Expeiienee 
and cautious attention giadually tauglit me how to use it Poi the last 
two yeais I have not liad occasion to altei the modes of management, 
but I am still fai from thinking them peifeet 
It would have been an easy task to have given select cases, vhose suc- 
cessful tieatment would liave spoken stiongly in favoui of the medicine, 
and pel haps been fiattering to my own leputation But Tiuth and 
Science would condemn the pioccduie I have theiefoie mentioned every 
case in which I have pieseiibed the Foxglove, pioper or improper, suc- 
cessful 01 otheiwise Such a conduct will lay me open to the censuie of 
those who aie disposed to censuie, but it ivill meet the appiobation of 
otheis, who aie the best qualified to be the judges 
To the Suigeons and Apothecaiies, with whom I am connected in prac- 
tice, both in this town and at a distance, I beg leave to make this public 
acknowledgement, foi the assistance they so leadily aifoided me, in pei- 
fecting some of the cases, and in communicating the events of otheis 
The ages of the patients aie not always exact, noi would the laboiu 
of making them so have been lepaid by any useful consequences In a 
few instances accuiacy in that lespect Avas necessaiy, and there it has 
been attempted, but in geneial, an approximation tOAvaids the truth, 
Avas supposed to be sufficient 

The eases related fiom my oavu expeiienee, aie geneially Aviitten in 
the shoitest foim I could continm, in ordei to save time and labour 
Some of them aie given more in detail, AAdien paiticulai eireumstanees 
made such detail necessaiy, but the cases eommumeated by othei piac- 
titioners, are given in their oavu Avoids 

»Withering, William An Account of the Foxglove, London, 1785 

[ 232 ] 



I must caution the reader, who is not a practitioner in physic, that no 
general deductions, decisive upon the failure or success of the medicine, 
can he drawn from the cases I now present to him These cases must 
be considered as the most hopeless and deplorable that exist, for phy- 
sicians are seldom consulted m chrome diseases, till the usual remedies 
have failed and, indeed, for some yeais, whilst I was less expert in 
the management of the Digitalis, I seldom presciibed it, but when the 
failuie of eveiy othei method compelled me to do it, so that upon the 
whole, the instances I am going to adduce, may tiuly be consideied as 
cases lost to the common run of practice, and only snatched from destruc- 
tion, by the efficacy of the Digitalis , and this in so remarkable a manner, 
that, if the propeities of that plant had not been discovered, by far the 
gieatest part of these patients must have died 
There aie men who wiU hardly admit of anything which an author 
advances m suppoit of a favoiite medicine, and I allow they may have 
some cause for their hesitation, nor do I expect they will wave then 
usual modes of judging upon the present occasion I could wish there- 
fore that such leadeis would pass over what I have said, and attend 
only to the communications fiom eoriespondents, because they cannot 
be supposed to possess any unjust predilection in favoi of the medicine 
but I cannot advise them to this step, for I am certain they would then 
close the book, with much highei notions of the efficacy of the plant than 
they would have learnt fiom me Not that I want faith in the discern- 
ment or in the veracity of my correspondents, for they are men of estab- 
lished leputation, but the eases they have sent me are, with some excep- 
tions, too much selected They aie not upon this account less valuable in 
themselves, but they aie not the proper premises from which to diaw 
peimanent conclusions 

I wish the leader to keep in view, that it is not my intention merely 
to intioduee a new diuretic to his acquaintance, but one which, though 
not infallible, I believe to be much more ceitain than any other in pres- 
ent use 

After all, m spite of opinion, prejudice, or eiior. Time will fix the leal 
value upon this discoveiy, and determine whethei I have imposed upon 
myself and otheis, oi contiibuted to the benefit of science and mankind 

Birmingham, 1st July, 1785 

INTRODUCTION 

The Foxglove is a plant sufficiently common m this island, and as we 
have but one species, and that so geneially known, I should have thought 
it supeifluous either to figuie oi desciibe it, had I not moie than once seen 
the leaves of Mullein’ gatheied foi those of the FoxgIo^e On the con- 
tinent of Euiope too, other species are found, and I have been infoimed 

‘Verbascum o£ Linnaeus 

[ 233 ] 



that om species is veiy laie in some paifs of Geiinan-^, existing only by 
means of cultivation, in gaidens 

Oiu plant IS the Digti(ih<f pwinnca^ oi Linnaeus It belongs to the 2d 
01 del of the 14th class, oi tlie Duhjncnma Angiospeimia The essential 
climacteis of the genus aie, Cnp with 5 divisions Blossom hell-shaped, 
bulging Capsule egg-shaped, 2-celled — Linn 
D/gitalis puipuiea Little lea\cs ot Ihe enipalcinent egg-shaped, sliaip 
Blossoms blunt, the uppei lip entiie Linn 

I have not obseived that any ot oui cattle eat it The loot, the stem, 
the leaves, and the flovcis lia\c a bittci heibaceous taste, but I don’t pei- 
ceive that nauseous bittei vhich has been attiibuted to it 
This plant laiiks amongst the Llkidai., one of the Lmnaean oideis 
111 a iiatuial si stem It has loi eongeneia, Nicoiiana, Aiiopa, Jlijoscijamus, 
Datuia, Solannm, etc so that iiom the knov ledge i\e possess of the viitues 
of those plants, and leasoning fioni botanical analog!, i\e might be led 
to guess at sometliing of its piopcities 

I intended in tins place to lune tiaced tlie Insloiy of its efleets in dis- 
eases fiom the tune of Fuehsius, who fiist dcsciibes it, but I haie been 
anticipated in this intention by mi leiv laliialile fiiend, Di Stokes of 
Stoui budge, ivho has lately sent me the folloiving 

HISTORICAL VIEW OF THE PROPERTIES OF DIQITALIS 

Fuehsius III his hist ship 1542, is the fiist authoi who notices it Fioni 
him it leceives its name of Digitalis, in allusion to the Geiniaii name of 
Fingeihuf, ivliich signifies a fingei -stall, liom the blossoms lesemhling the 
fingei of a glove 

Sensible Qualities Leaves bitteiish, veiy nauseous Lewis Mat ined I 
242 

Sensible Effects Some peisons, soon aftei eating of a kind of omolade, 
into ivliieh the leaies ot this, with those of seieial othei plants, had 
enteied as an ingiedient, found themselves much indisposed, and weie 
piesently aftei attacked ivith vomitings Dodonaeus peinpt 170 

It IS a medicine ivhich is piopei only foi stiong constitutions, as it puiges 
very violently, and excites excessive vomitings Bay hist 767 
Boeihaave judges it to be of a poisonous iiatnie, hist plant but Di 
Alston lanks it among those indigenous vegetables, “ivhich, though now 
disiegarded, aie medicines of gieat viitue, and scaicelv infeiioi to aiij 
that the Indies afford ” Lewis Mat med I p 343 

Six 01 seven spoonfuls of the decoction pioduce nausea and vomiting, 
and puige, not without some iiiaiks of a deleteiious quality — Ilallei hist 
n 330 fiom Aerial Infl p 49, 50 

tThe trivial name purpiiiea is not a verj happj one for the blossoms though generallj 
purplG, are soinetimes of a pure wlute 

[ 234 j 



The following is an abiidged Account of its Effects upon TuiLeys 
If Sale^ne, a physician at Oileans, having heaid that seveial tiiikey 
pouts had been killed by lieing fed with Foxglove leaves, instead of miillein, 
he gave some of the same leaves to a laige vigoioiis tin key The bud was 
so much affected that he could not stand upon his legs, he appeal ed drunk, 
and his excrements became i eddish Good nouiishment restoied him to 
health in eight days 

Being then deteiniiiied to push the exiieiiment fiiithei, he chopped 
some moie leaves, mixed them with bian, and gave them to a vigoious 
till key cock which weighed seven pounds This biid soon appealed 
diooping and melancholy, his featheis staled, his neck became pale and 
leti acted The leaves weie given linn for foiii days, dining which time 
he took about half a handful These leaves had been gatheied about 
eight days, and the wiiitei was fai advanced The ex elements, which 
aie natinally green and well foiiiied, became, fiom the fiist, liquid and 
1 eddish, like those of a dysenteiic patient 
The animal refusing to eat any moie of this mixtuie which had done 
him so much mischief, I was obliged to feed him with bian and watei 
only, but notwithstanding this, he eoiitinued drooping, and without ap- 
petite At times he was seized with convulsions, so stiong as to tliiow 
him down, in the mteivals he walked as if diinik, he did not attempt 
to peich, he utteied plaintive cues At length he refused all nouiish- 
ment On the fifth oi sixth day the excienieiits became as white as chalk , 
afteiwaids yellow, gieemsh, and black On the eighteenth day he died, 
gieatly i educed in flesh, foi he now weighed only tliiee pounds 
On opening him we found the heait, the lungs, the livei, and gall- 
bladdei shiunk and diied up, the stomach was quite empty, but not de- 
prned of its villous coat — Hist de VAcadem 1748, p 84 
Epilepsy — “It hath beeiie of latei expeiience found also to be effectual 
against the tailing sicknesse, that diveis have been cured theiebv, foi aftei 
the taking of Decoct mampulo) ii c polypod quo cm contus Ziv m 
cetevisia, they that have been tioubled with it twenty-six yeais, and have 
fallen once in a weeke, oi two oi thiee times in a moneth, have not fallen 
once 111 fourteen or fifteen moneths, that is until the viiting heieof ” — 
Pm kmson, p 654 

Soopimla — “The heib biuised, oi the luiee made up into an ointment, 
and applied to the place, hath been found liv late expeiience to be availeable 
for the King’s Evill “ — Pail p 654 

Seieial heieditaiv instances of this disease said to haie been cuied by 
it Acnal Influences, p 49, 50, quoted by Hallo , hist n 330 
A man vith so opinions ulcos in laiious paits of the bodv, and vhieh 
in the light leg veie so Miulent that its amputation uas pioposed, cined 
bv Slice cipicss cocll i his iniia ni dies, in pinta co ciisiac calidac 

[ 235 ] 



The leaves lemaining aftei the piessmg out of the juice, were apphed 
every day to the ulceis — Piaci ess p 40, quoted by Muiiay appmat 
medicam ^ p 491 

A young woman with a sciopimlous tumoui of the eye, a lemarkable 
swelling of the uppei lip, and painful tumonis of the joints of the fingeis, 
much lelieved, hut the medicine was left off, on account of its violent ef- 
fects on the constitution — Ih p 42 quoted as above 
A man with a sciophulous tumoui of the light elbow, attended for three 
yeais ivith excruciating pains, was neailj’- cuied by foui doses of the juice 
taken once a month — Ib p 43 as above 
The physicans and siiigeons of the 'Woicestei Inliimaiy have employed 
it in ointments and poultices with lemaikable efficacy — Ib p 44 It was 
lecommended to them by Di Baylies of Evesham, now of Beilin, as a 
lemedy foi this disease Di Wall gave it a tiyal, as well externally as 
internally, but then expeiiments did not lead tliem to obseive any other 
properties in it, than those of a highly nauseating medicine and diastic 
purgative 

Wounds In consideiable estimation foi tlie healing of all kinds of 
wounds — Lobel adv 245 

Piincipally of use in uleeis, winch discliaige considerably, being of lit- 
tle advantage in such as aic diy — IIulsc, in R hist 768 
Doctor Barjlies, physician to his Piussian Majesty, infoimed me, when 
at Beilin, that he employed it with gieat success in canes, and obstinate 
sole legs 

Dyspnoea Pituitosa Sauvages I 657 — “Boiled in water, oi wine, and 
drunken doth cut and consume the tliickc toiiglinesse of giosse, and sliraie 
flegme, and naiightie humouis Tlie same, oi boiled with honied water 
01 sugar, doth scour e and dense the biest, iipeneth and bung fooith 
tough and elammie flegme It openeth also the stoppage of the livei 
spleene and milt, and of the inwaide pails ” — Gerarde hist ed 1, p 647 
“Whensoever there is need of a laiefjung oi extenuating of tough flegme 
or viscous humouis troubling the chest, — the decoction or juice hereof 
made up with sugar oi honey is availeable, as also to dense and piiige 
the body both upwards and downwards sometimes, of tough flegme, and 
clammy humours, notwithstanding that these qualities are found to bee in 
it, there are but few physitions in oui times that put it to these uses, but it 
IS in a manner wholly neglected ” — Parkinson, p 654 
Previous to the year 1777, you informed me of the gieat success you had 
met with in curing dropsies by means of the foi Digitalis, which you then 
considered as a more certain diuretic than any jmu had ever tried Some- 
time afterwards, Mr Russel, surgeon, of Worcester, having heard of the 
success which had attended some eases in which you had given it, requested 

[ 236 ] 



me to obtain foi him any infoimatioii you might be inclined to communi- 
cate lespecting its use In consequence of this application, you Aviote to me 
in the following teims 

In a letter which I received fiom jmu in London, dated September 29, 
1778, you write as follows —“I wish it was as easy to wiite upon the 
Digitalis— I despaii of pleasing m 3 ^self oi instiucting otheis, in a subject 
so difficult It IS much easier to write upon a disease than upon a lemedj^ 
The formei is in the hands of natuie, and a faithful obseiver, with an eye 
of toleiable judgement, cannot fail to delineate a likeness The lattei will 
ever be subject to the whims, the maccuiacies, and the blunders of man- 
kind ” 

In mj’’ notes I find the following memoiandum — “Febiuaiy 20th, 1779, 
gave an account of Doctoi Withering’s practice, with the piecautions neces- 
sary to its success, to the Medical Society at Edinburgh ” — In the course of 
that j’-eai, the Digitalis was piesciibed in the Edinbuigh Infirmaiy, by Di 
Hope, and in the following j^ai, whilst I was Cleik to Di Home, as Clin- 
ical Professor, I had a favouiable opportunity of obseiving its sensible 
effects 

In one case in which it was given pioperty at fiist, the mine began to 
flow fieelj'- on the second daj'’ On the third, the swellings began to sub- 
side The dose was then inci eased more than qtiadmple in the twenty- 
foui houis On the fifth day sieloiess came on, and much puiging, but the 
mine still increased though the pulse sunk to 50 On the 7th day, a 
qmdniple dose of the infusion was oideied to be taken eveiy thud lioui,' 
so as to bung on nausea again The pulse fell to foitj^-fom, and at lengtli 
to thiity-five in a minute The patient graduallj’- sunk and died on the 
sixteenth daj’’, but pievious to her death, for two oi thiee days, her pulse 
rose to neai one hundied — It is needless to observe to jmu, how widelj" tlie^ 
tieatment of this case diffeied from the method which j^ou have found so 
successful 


AN ACCOUNT OF THE INTRODUCTION OF FOXQLOVE 
INTO MODERN PRACTICE 

As the moie obvious and sensible piopeities of plants, such as eolom, 
taste, and smell, have but little connexion with the diseases they aie 
adapted to erne, so then peculiai qualities have no eeitani dependence 
upon then external configuiation Then chemical examination ly file, 
aftei an immense waste of time and laboui, liaMiig been found useless, 
IS non abandoned by geneial consent Possibly othei modes of anal 3 ’’sis 
will be found out, vhieh may tuin to bettei account but u e ha^e hithei- 
to made onlv a ^ely small piogiess in the chemistiA’- of animal and ^ege- 
table substances Then Mitues must theiefoie be leaint eithei fiom 

[2S7] 



obseiviiig then effects iiiion insects and quadnipeds, fiom analogy, de- 
duced fiom the alieady known poweis of some of then congeneia, oi 
from the empnieal usages and expeiience of the populace 

The fiist method has not yet been mucli attended to, and the second 
can only be peifeeted in piopoition as we appioach towaids the diseoveiy 
of a tiuly natinal system, but the last, as fai as it extends, lies within 
the leacli of eveiy one who is open to infoimation, legaidless of the 
soince fiom whence it spiings 

It Avas a cncumstance of this kind which fiist fixed my attention on 
the Foxglove 

In the yeai 1775, my opinion was asked conceining a family leceipt 
foi the cine of the diopsj’’ I Avas told that it had long been kept a seeiet 
by an old AAmman in Shiopshne, Aidio had sometimes made cuies aftei 
the moie legulai piactitioneis had failed I Aims infoimed also, that the 
effects pioduced Aveie Aoolent Aomiting and pinging, foi the diinetic 
effects seemed to liaA'^e been oaci looked This medicine Aias composed of 
tAventy oi moie diffeient heibs, but it A\as not veiy difficult foi one 
coiweisant in these subjects, to peicene, that the actn^e heib could be no 
othei than Foxglove 

My AAmithy piedeeessoi in this place, the acij" humane and ingenious 
Di Small, had made it a piaetice to gnm his adAoce to the pool duiing 
one lioui in a day This piaeticc, aaIucIi I continued until Ave had an 
Hospital opened foi the leeeption of the sick pooi, gave me an oppoi- 
tuinty of putting my ideas into execution in a Aaiiety of cases, foi the 
numbei of poor Avho thus applied foi advice, amounted to betn’-een tiio 
and tliiee thousand anniiallj^ I soon found the Foxgloim to be a a^cia’’ 
poAveifiil diiiietic, but then, and foi a consideiable time aftei Aimids, I 
gave it 111 doses veiy much too laige, and iiiged its continuance too long , 
foi misled by leasoning fiom the effects of the squill, Aidiicli genei allj’ 
acts best upon the kidneys Aiffien it excites nausea, I AAoshed to piodiiee 
the same effect by the Foxgloie In this mode of piesciibing, Avhen I 
had so many patients to attend to in the space of one oi at most of tivo 
houis, it Avill not be expected that I could be Aeiy paiticiilai, much less 
could I take notes of all the cases A\dnch occiiiied Turn oi tliiee of them 
only. 111 which the medicine succeeded, I find mentioned amongst my 
papers It Avas fiom this kind of expeiience that I ventiiied to asseit, 
in the Botanical Aiiangement published in the couise of the folIoAiang 
spiing, that the Digitalis piiipiiiea “meiited moie attention than modeiii 
piactice bestoAved upon it ” 

I had not, hoAvevei, yet intioduced it into the moie legiilai mode of 
piesciiption, but a cii ciimstance happened Avhich aeceleiated that event 
My tiuly Amliiable and lespeetable fiiend, Di Ash, infoimed me that Di 
CaAvley, then piincipal of Biazen Nose College, Oxfoid, had been ciiied 
of a Hydiops Pectoiis, by an empuical exhibition of the loot of the Fox- 

[238] 



glove, aftei some of the fiist physicians of the age had declaied they 
could do no more foi him I was now detei mined to puisne my foimer 
ideas moie vigoiously than befoie, but was too well aware of the im- 
ceitainty which must attend on the exhibition of the loot of a hienmal 
plant, and therefore continued to use the leaves These I had found to vaiy 
much as to dose, at dilfeient seasons of the yeai , but I expected, if gathered 
always in one condition of the plant, viz when it was in its floweiing state, 
and eaiefiilly diied, that the dose might be ascei tamed as exactly as that 
of any other medicine, nor have I been disappointed in this expectation 
The more I saw of the gieat powers of this plant, the moie it seemed neces- 
sary to bring the doses of it to the greatest possible aeeuiacy I suspected 
that this degree of accuracy was not leconeileable with the use of a 
decochon, as it depended not onlj’- upon the care of those who had the 
preparation of it, but it was easj’’ to conceive from the analogj’’ of another 
plant of the same natiiial order, the tobacco, that its active properties 
might be impaired by long boiling The decoction was therefore discarded, 
and the infusion substituted in its place After this I began to use the 
leaves in ‘powder, but I still verj^ often prescribe the infusion 

Fiiithei expel leiiee convinced me, that the diuretic eifeets of this medi- 
cine do not at all depend upon its exciting a nausea or vomiting, but, 
on the eontiaiy, that though the increased secretion of urine will frequently 
succeed to, or exist along with these eiicumstances, yet they are so far 
from being friendly or neeessaij^ that I have often known the discharge 
of urine checked, when the doses have been imprudently urged so as to 
occasion sickness 

If the medicine purges, it is almost certain to fail in its desired effect, 
but this having been the case, I have seen it afterwards succeed when 
joined with small doses of opium, so as to restrain its action on the bowels 

In the summer of tlie year 1776, I ordered a quantity of the leaves to be 
dried, and as it then became possible to ascertain its doses, it was gradu- 
ally adopted by the medical practitioners in the circle of my acquaintance 

In the month of November 1777, in consequence of an application from 
that very celebrated surgeon, Mr Russel, of Worcester, I sent him the 
tollovmg account, which I choose to introduce here, as showing the ideas 
I then entei tamed of the medicine, and how much I was mistaken as to 
its real dose — “I generally order it m decoction Three drams of the 
dried leaves, collected at the time of the blossoms expanding, lioiled in 
twelve to eight ounces of watei Two spoonfuls of tins medicine, gnen 
eieiv tvo houis, vill sooner or later excite a nausea I hare sometimes 
used the green leaves gathered in winter, but then I order thiee times the 
weight, and m one instance I used three ounces to a pint decoction, befoie 
the desired effect took place I considered the Foxglove thus guen, as the 
most eeitam diuretic I laiow^, nor do its diuretic effects depend meieh 
upon the nausea it pioduces, for in cases where squill and ipecac bare 

[ 23e ] 



been so given as to keep up a nausea seveial days togethei, and the flow 
ot mine not taken place, I have lound the Foxglove to succeed, and I 
have, in moic than one instance, given the h''oxglove in smaller and moie 
distant doses, so that Ihe flow oi mine has taken place without any sensible 
affection of the stomach, but in geneial I give it in tbe manner first men- 
tioned, and 01 del one dose to be taken altei tbe sickness commences I 
then omit all medicines, except those oi the coidial kind aie wanted, duiing 
the space ol thiee, lorn, oi five days By this lime the nausea abates, and 
the appetite becomes bettei than it was beioic Sometimes the biain is 
consideiably affected b 3 " tlie medicine, and indistinct vision ensues, but 
I have ne\ei yet iound any peimanent bad effects fiom it ” 

“I use It in the Ascites, Anasaica, and Ilydiops Peetoiis, and so fai as 
the lemoval oi the watei ivill contiibule to euie the patient, so fai may be 
expected iiom tins medicine but I wish it not to be tiied in ascites of 
female patients, believing that many oi these cases aie diopsies of the 
ovaiia, and no sensible man -will evei expect to see these enevsted fluids 
lemoved by any mediemc ” 

“I have often been obliged to evacuate the vatei lepeatedlv in the same 
Iiatient, bi lepcatiiig tlie decoction, but then this has been at such distance 
of time as to allow of the intcifeience of othci medicines and a piopei 
legimen, so that the patient obtains in the end a peifeet erne In these 
eases the decoction becomes at length so veij disagieeable, that a much 
smallei quantity will pioduee the eflecl, and I oiten find it necessaiy to 
altei its taste bv the addition oi Aq Ciniiam sp oi Aq Junipei eom- 
posita ” 

“I allow, and indeed enioin mj' patients to dunk ^el^ plentiiully oi 
small liquois thiough the whole couise ot the cine, and sometimes, where 
the evacuations have been veij' sudden, I have found a bandage as neces- 
saij’- as in the use oi the tiochai ” 

Early in the j’-eai 1779, a iiumbei oi dropsical cases offered themselves 
to my attention, the consequences of the scarlet ievei and sore throat 
which had raged so veij’’ generally amongst us in the preceding jmai Some 
of these had been cured by squills ot other diuretics, and relapsed, in 
others, the diopsy did not appear for several weeks after the original dis- 
ease had ceased but I am not able to mention many paitieulais, having 
omitted to make notes This, however, is the less to be regretted, as the 
symptoms in all were very much alike, and they were all without an excep- 
tion cured by the Foxglove 

This last circumstance encouraged me to use the medicine more fre- 
quently than I had done heretofore, and the increase of practice had 
taught me to improve the management of it 

In February 1779, my friend. Dr Stokes, communicated to the Medical 
Society at Edinburgh the result of my experience of the Foxglove, and, 
letter addressed to me in November following, he saj^s, “Di Hope, 

[ 240 ] 


in a 



in consequence of my mentioning its use to mj'’ fiiend, Di Biouglitoii, 
has tried the PoxgloA^e m the Infiimaiy with success ” Di Stokes also 
tells me that Dr Hamilton cuied diopsies with it in the yeai 1781 
I am infoimed by my veiy woithy fiiend Di Duncan, that Dr Hamil- 
ton, who leaint its use from Di Hope, has employed it veiy fiequently 
in the Hospital at Edmliuigh Di Duncan also tells me, that the late 
veiy ingenious and accomplished Mi Chailes Dai win, infoinied him of 
Its being used by his fathei and myself, in eases of Hydiothoiax, and 
that he has evei since mentioned it in his lectuies, and sometimes em- 
ployed it in his piactice 

At length, in the yeai 1783, it appealed in the new edition of the 
Edinbuigh Phaimacopoeia, into which, I am told, it was leceived in con- 
sequence of the leeoniinendation of Di Hope But from which, I am sat- 
isfied, it will be again veiy soon rejected, if it should continue to be ex- 
hibited 111 the uni esti allied mamiei in which it has heietofoie been used 
at Edinbuigh, and in the enoinious doses in which it is now diieeted in 
London 

In the following eases the leadei will find othei diseases besides diop- 
sies, paitieulaily seveial cases of consumption I was induced to tiy it 
in these, fiom being told, that it was much used in the West of England, 
111 the Phthisis Pulmonalis, by the common people In this disease, how- 
evei, 111 my hands, it has done but little seivice, and yet I am disposed 
to wish It a fiuthei tiial, foi in a copy of Paikinson’s Heibal, which I 
saw about two veais ago, I found the following inanusciipt note at the 
aiticle Digitalis, wiitten I believe, bj’’ a Mi Saundeis, who practiced foi 
many yeais with gieat leputation as a suigeoii and apothecaij'" at Stoui- 
biidge, in Woicesteishiie 

“Consumptions aie cuied infallibly by weak decoction of Foxglove 
leaves in uatei, oi wine and watei, and diaiik foi constant dunk Oi 
take of the juice of the heib and floweis, claiify it, and make a fine sjuup 
with honey, of Avhich take thiee spoonfuls tin ice in a day, at physical 
houis The use of these two things of late has done, in consumptive 
cases, gieat Avondeis But be cautious of its use, foi it is of a vomiting 
natuie In these things begin spaimgly, and inciease the dose as the pa- 
tient’s stiength will beai, least, instead of a soveieign medicine, you do 
leal damage by this infusion oi syiup ” 

Tlie piecautioiis annexed to his encomiums of this medicine, lead one 
to think that he has spoken fiom his oun piopei expeiienee 

I liaie latelv been told, that a peisoii in the neighboihood of Waiuick, 
possesses a famous family leeeipt foi the diopsy, in uhich the Poxgloie 
is the actne medicine, and a lady fiom the ucstern pait of Yoikshire 
assuies me, that the people in hei eountiy often erne themsehes of 
diopsical com])laints by dunking Foxgloie tea In confiimation of this, 
I leeollopl about two leais ago being desned to Msit a tiaielling Yoik- 

[241 1 



shire tiadesmaii I found liim incessantly vomiting, liis vision indistinct 
his pulse forty in a minute Upon enquiiy it came out, that his wife had 
stewed a laige handful of gieen PoxgloAe leaves in a half a pint of watei, 
and given him the liquoi, which he diank at one di aught, m older to 
cure him of an asthmatic affection This good woman knew the medi- 
cine of hei eountiy, but not the dose of it, foi hei husband naiiowly es- 
caped with his life 

It IS probable that this lude mode of exhibiting the Foxglove has been 
more geneial than I am at piesent awaie of, but it is wondeiful that no 
authoi seems to have been acquainted with its effects as a diuietic 


OF THE PREPARATIONS AND DOSES OF THE FOXQLOVE 

Eveiy pait of the plant has moie oi less the same bittei taste, vaiying, 
however, as to stiength, and changing Avith the age of the plant and the 
season of the yeai 

Boot — This vanes gieatlj" with the age of the plant When the stem 
has shot up foi floweiing, which it does the second yeai of its giovdh, the 
root becomes diy, neaily tasteless, and ineit 

Some piaetitioners, who have used the loot, and been so happy as to 
cuie their patients without exciting sickness, haie been pleased to com- 
municate the ciicumslance to me as an impiovement in the use of the plant 
I have no doubt of the tiuth of then lemaiks, and I thank them But 
the case of Di Cawle}^ puts this mattei bejond dispute The fact is, 
they have fortunatel}^ happened to use the loot in its appioach to its ineit 
state, and consequently have not ovei dosed then patients I could, if 
necessary, bung othei pi oof to shew that the loot is just as capable as the 
leaves, of exciting nausea 

Stem — The stem has moie taste than the root has, in the season the 
stem shoots out, and less taste than the leaves I do not know that it has 
been particulaily selected foi use 

Leaves — These vaiy gieatly in then efficacy at diffeient seasons of 
the year, and, peihaps, at different stages of then giowth, but I am not 
certain that this vaiiation keeps pace with the greater oi lesser intensity 
of their bitter taste 

Some who have been habituated to the use of tlie lecent leaves, tell me, 
that they answei then pin pose at eveij’’ season of the yeai , and I be- 
lieve them, notwithstanding I myself have found veiy gieat vaiiations in 
this respect The solution of this difficultj’- is obvious They have used the 
leaves in such laige propoition, that the doses have been sufficient, oi moie 
than sufficient, even in then most inefficacious state The leafstalks seem, 
in their sensible properties, to paitake of an intei mediate state between 
the leaves and the stem 


[242 ] 



Flowers — The petals, the chives, and the pointal have nearly the taste of 
the leaves, and it has been suggested to me, by a very sensible and ;)udi- 
cious friend, that it might be well to fix on the flower for internal use I 
see no objection to the pioposition, but I have not tried it 
Seeds — These I believe aie equally untiied 

From this view of the different parts of the plant, it is sufficiently ob- 
vious why I still continue to prefer the leaves 
These should be gathered after the fioweiing stem has shot up, and 
about the time that the blossoms are coming foith 
The leaf -stalk and mid-rib of the leaves should be rejected, and the 
leraaining part should be dried, either in the sun-shine, or on a tin pan or 
pewter dish befoie a fire 

If well dried, they readily rub down to a beautiful green powder, which 
weighs something less than one-fifth of the original weight of the leaves 
Care must be taken that the leaves be not scorched in drying, and they 
should not be dried more than what is requisite to allow of their being 
readily reduced to powder 

I give to adults, fiom one to three grams of this powder twice a day 
In the reduced state in which physicians generally find dropsical patients, 
four grains a day aie sufficient I sometimes give the powder alone, some- 
times unite it with aromatics, and sometimes form it into pills ivith a 
sufficient quantity of soap or gum ammoniac 
If a liquid medicine be preferred, I order a dram of these dried leaves 
to be infused for four hours in half a pint of boiling water, adding to the 
strained liquor an ounce of any spiiitous water One ounce of this infusion 
given twice a day, is a medium dose for an adult patient If the patient 
be stronger than usual, or the symptoms very urgent, this dose may be 
given once in eight houis, and on the contrary in many instances half an 
ounce at a time will be quite sufficient About thirty grains of the powder 
01 eight ounces of the infusion, may generally be taken befoie the nausea 
commences 

The ingenuity of man has ever been fond of exerting itself to vary 
the foims and combinations of medicines Hence we have spirituous, 
vinous, and acetous tmctuies, extracts hard and soft, syrups with sugar 
or honey, etc but the more we multiply the forms of any medicme, the 
longer we shall be m ascertaining its real dose I have no lasting objection 
howevei to any of these formulae except the extract, which, from the 
nature of its piepaiation must ever be uncertain m its effects, and a 
medicine whose fullest dose in substance does not exceed three grains, 
cannot be supposed to stand in need of condensation 

It appears from several of the cases, that when the Digitalis is dis- 
posed to purge, opium may be joined with it advantageously, and when 
the hovels aie too taidy, jalap may be gnen at the same time without in- 
teifeiiiig vith Its diuietie effects, but I ha\e not found benefit from any 
othei adjunct 


[ 243 ] 



Fiom tins view of the doses in which tlie Digitalis leally ought to be 
exhibited, and fiom the evidence of man3^ of the cases, in which it appeals 
to have been given in quantities six, eight, ten or even twelve times moie 
than necessary, we must admit as an infeience eithei that this medicine 
IS perfectly safe when given as I advise, oi that the medicines in daily use 
aie highlj'- dangeious 

EFFECTS, RULES AND CAUTIONS 

The Foxglove when given in veiy large and quickl}^ lepeated doses, 
occasions sickness, vomiting, purging, giddiness, confused vision, objects 
appealing gieen oi jmllow, inci eased secietion of uiine, with frequent 
motions to pait with it, and sometimes inabilitj^ to letaiii it, slow pulse, 
even as slow as 35 in a minute, cold sweats, convulsions, sjnicope, death ^ 
When given in a less violent mannei, it pioduces most of these effects in 
a lowei degzee, and it is euiious to obseive, that the sickness, with a cei- 
tain dose of the medicine, does not take place foi manj’- houis aftei its 
exhibition has been discontinued, that the floiv of uiine will often piecede, 
sometimes accompanjq fiequently follow the sickness at the distance of 
some daj^s, and not mfrequentlj'^ be checked bj^ it The sickness thus ex- 
cited, IS extiemely diffeient fiom that occasioned by any othei medicine, 
it IS peeuliailj" distiessing to the patient, it ceases, it leeuis again as 
violent as befoie, and thus it will continue to lecui foi tlnee oi foni daj's, 
at distant and moie distant inteivals 

These suffeiings of the patient aie geneially lewaided bj a letuin of 
appetite, much gieatei than what existed befoie the taking of the medicine 
But these suffeiings aie not at all necessaij’, they aie the effects of oui 
mexpeiience, and would in similar ciicumstances, moie oi less attend the 
exhibition of almost everj" active and poweiful medicine we use 

Peihaps the leader will bettei undeistand how it ought to be given, 
fiom the following detail of 1113^ own impiovement, than fiom piecepts 
peiemptoiily deliveied, and then souice veiled 111 obsciiiitj’^ 

At fiist I thought it neeessaiy to hixng on and continue the sicLncss in 
01 del to ensui e the dmietic effects 

I soon leaint that the nausea being once excited, it ivas unnecessaiy 
to lepeat the medicine, as it was ccitain to lecui fiequentlj^, at inteivals 
moie 01 less distant 

Theiefoie m3’' patients weie oideied to peisist until the nausea came on, 
and then to stop But it soon appealed that the dmietie effects would 
often take place fiist, and sometimes be checked when the sickness or a 
purging supervened 

The diiection was theiefoie enlaiged thus — Continue the medicine until 
the wine flotvs, 01 sichness 01 puiging takes place 

»I am doubtful whether it does not sometimes excite a copious flou of saiiva 

[ 244 ] 



I found myself safe undei this legulation foi two or three years, but 
at length cases oecuired in which the pulse would be retarded to an alarm- 
ing degiee, without any other pieeedmg effect 

The directions theiefoie requiied an additional attention to the state of 
the pulse, and it was moreovei of consequence not to repeat the doses too 
quickly, but to allow sufficient time foi tlie effects of each to take place, 
as it was found very possible to pour in an in^uiious quantity of the medi- 
cine, before any of the signals for forbearance appeared 
Let the medicine theiefoie he given in the doses, and at the inteivals 
mentioned above — let it he continued until it eithei acts on the Tudneys, 
the stomach, the pulse, oi the bowels, let it he stopped upon the fiist ap- 
peal ance of any one of these effects, and I ivill maintain that the patient 
will not suffer fiom its exhibition, nor the piactitioner be disappointed in 
any leasonable expectation 

If it purges, it seldom succeeds well 

The patient should be enjoined to dunk verj^ freeV dining its opera- 
tion I mean, they should dunk whatevei they prefei, and in as great 
quantity as their appetite for dunk demands This direction is the moie 
necessary, as they are veiy generally prepossessed with an idea of diying 
up a dropsy, by abstinence fiom liquids, and fear to add to the disease, 
by indulging then inclination to dunk 

In eases of ascites and anasarca, when the patients aie weak, and the 
evacuation of the watei lapid, the use of piopei bandage is indispensably 
necessaiy to then safety 

If the water should not be wholly evacuated, it is best to allow an in- 
teival of seveial days before the medicine be repeated, that food and tonics 
may be administered, but truth compels me to say, that the usual tome 
medicines have in these cases veiy often deceived my expectations 
Piom some cases which have oceuried in the eouise of the piesent yeai, 
I am disposed to believe tliat the Digitalis may be given in small doses, 
viz two 01 thiee grains a day, so as gradually to remove a dropsy, without 
any othei than mild diuretic effects, and without any inteiruption to its 
use until the cine be completed 

If inadveitently the doses of the Foxglove should be pi escribed too 
laigely, exhibited too lapidly, oi uiged to too great a length, the knowl- 
edge of a lemedv to counteiact its effects would be a desiiable thing Such 
a lemedy may peihaps in time be discoveied The usual cordials and 
\olatiles aie generally i ejected fiom the stomach, aiomatics and strong 
bitteis aie longer letained, brandy will sometimes lemove the sickness 
nhen only slight, I have sometimes thought small doses of opium useful, 
but I am moie confident of the advantage from blisters ]\Ir Jones in one 
ease, found mint tea to be retained longei than other things 

[ 245 ] 



CONSTITUTION OF PATIENTS 

Independent of the degiee of disease, oi of the stxength oi age of the 
patient, I have had occasion to lemaik, that theie aie ceitain constitutions 
favouiable, and otheis unfavouiable to the success of the Digitalis 
From large experience, and attentive obseivation, I am pretty well 
enabled to decide a pi ion upon this mattei, and I wish to enable otheis 
to do the same but I feel myself hardly equal to the undertaking The 
following hints, howevei, aiding a degiee of experience in otheis, may lead 
them to accomplish what I yet can desciibe but impel fectly 
It seldom succeeds in men of gieat natuial stiength, of tense fibre, of 
warm skin, of floiid complexion, oi in those with a tight and eordy pulse 
If the belly in ascites be tense, hard, and ciicumsciibed, oi the limbs in 
anasaica solid and lesisting, we have but little to hope 

On the eontiaiy, if the pulse be feeble oi inteimitting, the countenance 
liale, the lips livid, the skin cold, the swollen belly soft and fluctuating, 
01 the anasarcous limbs leadily pitting undei the piessure of the finger, 
we may expect the diuietic effects to follow in a kindly manner 
In cases which foil eveiy attempt at lelief, I have been aiming, for 
some time past, to make such a change in the constitution of the patient, 
as might give a chance of success to the Digitalis 
By blood-letting, by neutial salts, by ciystals of taitai, squills and 
occasional puiging, I have succeeded, though impeifectly Next to the 
use of the lancet, I think nothing loweis the tone of the system more 
effectually than the squill, and consequently it will always be pioper, in 
such eases, to use the squill , f oi if that fail in its desn ed effect, it is one 
of the best piepaiatives to the adoption of the Digitalis 
A tendency to paialytie affections, oi a stioke of the palsy having 
actually taken place, is no objection to the use of the Digitalis, neithei 
does a stone existing in the bladdei foibid its use Theoietical ideas of 
sedative effects in the foimei, and appiehensions of its excitement of the 
uiiiiary oigans in the lattei case, might opeiate so as to make us with- 
hold lelief fiom the patient, but experience tells me, that such appre- 
hensions aie gioundless 

INFERENCES 

To prevent any impiopei influence, which the above lecitals of the 
efficacy of the medicine, aided by the novelty of the subject, may have 
upon the minds of the youngei pait of my leadeis, in laising their ex- 
pectations to too high a pitch, I beg leave to deduce a few infeiences, 
which I appiehend the facts will fairly suppoit 

I That the Digitalis will not universally act as a diuietie 
II That it does do so more geneially than any other medicine 
III That it will often produce this effect aftei eveiy other piobable 
method has been fruitlessly tried 

[ 246 ] 



IV That if this fails, there is but little chance of any othei medicine 
succeeding 

V That in piopei doses, and undei the management now pointed out, 
it IS mild in its opeiation, and gives less disturbance to the system 
than squill, or almost any othei active medicine 

VI That when diopsy is attended by palsy, unsound viscera, great 
debility, or other complication or disease, neither the Digitalis, nor 
any othei diuretic can do more than obtain a truce to the urgency 
of the sylnptoms, unless by gaming time, it may afford oppor- 
tunity for othei medicines to combat and subdue the oiiginal 
disease 

VII That the Digitalis may be used with advantage in eveiy species of 
dropsy, except the encysted 

VIII That it may be made subseivient to the cure of diseases, uncon- 
nected with dropsy 

IX That it has a powei ovei the motion of the heait, to a degiee yet 
unobserved in any other medicine, and that this power may be 
converted to salutaiy ends 

PRACTICAL REMARKS ON DROPSY, AND SOME OTHER DISEASES 

The following remarks consist partly of matter of fact, and partly of 
opinion The former will be peimanent, the latter must vary with the 
detection of erioi, oi the improvement of knowledge I hazard them 
with diffidence, and hope they will be examined with candour, not by a 
contrast with othei opinions, but by an attentive comparison with the 
phenomena of disease 

Anasat ca 

1 The anasarca is generally cuiable when seated in the sub-cutaneous 
cellular membrane, oi in the substance of the lungs 

2 When the abdominal visceia in general are gieatly enlarged, which 
they sometimes aie, without effused fluid in the cavity of the abdomen, 
the disease is incurable After death, the more solid visceia are found 
veiy large and pale If the cavity contains water, that watei may be 
lemoved by diuietics 

3 In swollen legs and thighs, wheie the resistance to piessuie is con- 
siderable, the tendency to tianspaiency in the skin not obvious, and 
wheie the alteiation of postuie occasions but little alteration in the state 
of distention, the cui e cannot be effected by dim etics 

Is this difficulty of cine occasioned by spissitude in the effused fluids, 
by want of piopei communication fiom cell to cell, oi is the disease lather 
caused by a morbid growth of the solids, than by an accumulation of 
fluid? 

Is not this disease in the limbs similai to that of the viscera (2) ? 

[ 247 ] 



4 Anasazcoiis swelhngs often take place in palsied limbs, in aims as 
well as legs, so that the swelling does not depend meiely upon position 

5 Is theie not cause to suspect that many dropsies originate fiom 
paralytic affections of the lymphatic alisoi bents ^ And if so, is it not 
piobable that the Digitalis, which is so effectual in lemoving diopsy, may 
also be used advantageously in some kinds of palsy’ 

Asctics 

6 If existing alone (t e ) without accompanying anasaica, is in childien 
cuiable, in adults geneially mem able by medicines Tapping may be 
used heie with bettei chance for success than in nioie complicated dropsies 
Sometimes cured by vomiting 

Ascites and Anasaica 

7 Incurable if dependent upon iiieinediaW^’- diseased visceia, oi on a 
gouty constitution, so debilitated, that the gouty paioxysms no longei 
continue to be foimed 

In every othei situation the disease 3 ’’ields to diuretics and tonics 

Ascites, Anasai ca, and JTydi othoi ax 

S Undei this complication, though the sj^ptoms admit oi iclicf, the 
restoration of the constitution can haxdly be hoped foi 

Asthma 

9 The true spasmodic asthma, a laie disease — is not lelieved by 
Digitalis 

10 In the greatei pait oi what aie called asthmatical cases, the leal 
disease is anasaica of the lungs, and is geneially to be ciued by diuretics 
(See 1 ) This is almost alwaj^s combined with some swelling of the legs 

11 Theie is another kind of asthma, in which change of posture does 
not much affect the patient I believe it to be caused by an infaiction 
of the lungs It is incurable by diuietics, but it is often accompanied 
with a dcgiee of anasaica, and so far it admits of lelief 

Is not this disease similar to that in the limbs at (3) and also to that 
of the abdominal viscera at (2) ’ 

Asthma and Anasaica 

12 If the asthma be of the kind mentioned at (9 and 11) diuietics 
can only remove the accompanying anasaica But if the affection of the 
breath depends also upon cellular effusion, as it mostly does, the patient 
may be taught to expect a lecovery 

Asthma and Ascites 

13 A raie combination, but not incuiable if the abdominal visceia are 
sound The asthma is here most probably of the anasareous kind (10) , 

[248 ] 



and this being seldom confined to the lungs onlj’’, the disease genei ally 
appears in the following foim 

Asthma, Ascites, and Anasa^ ca 

14 The eiu ability of this combination will depend upon the circum- 
stances mentioned in the pieceding section, taking also into the account the 
strength oi weakness of the patient 

Epilepsy 

15 In epilepsy dependent upon eftusion, the Digitalis will effect a cuie, 
and in the cases alluded to, the dropsical symptoms weie unequivocal It 
has not had a sufficient tiial in my hands, to deteimine what it can do in 
other kinds of epilepsy 

Hydatid Hi opsy 

16 This may be distinguished fiom common ascites, by the want of 
evident fluctuation It is common to both sexes It does not admit of a 
cuie eithei by tapping or by medicine 

Hydi ocephalus 

17 This disease, which has of late so much atti acted tlie attention of the 
medical woild, I believe, oiigmates in inflammation, and that the watei 
found 111 the ventricles of the biain aftei death, is the consequence, and not 
the cause of the ilhiess 

It has seldom happened to me to be called upon in the eailiei stages of 
this complaint, and the symptoms are at first so similar to those usualty 
attendant upon dentition and woims, that it is very difficult to pronounce 
decidedly upon the real natuie of the disease, and it is lather fiom the 
failuie of the usual modes of lelief, than fiom any othei moie decided 
observation, that we at length dare to give it a name 


Hydi othoi ax 

18 Undei this name I also include the diopsy of the peiicaidium The 
intermitting pulse, and pain in the aims, sufficiently distinguish this dis- 
ease fiom asthma, and from anasaicous lungs 

It IS very univei sally euied by the Digitalis 

19 I lately met ivith two eases which had been consideied and tieated 
as angina peetoiis They both appealed to me to be cases of hvdrothoiax 
One subject uas a cleigyman, whose stiength had been so compleatly ex- 
hausted bv the continuance of the disease, and the attempts to lelieve it, 
that he did not suiMve many days The othei was a lady, uliose time of 
life made me suspect effusion I diiected hei to take small doses of the 
puh Digitalis, which in eight davs lemoved all her complaints This 
happened six months ago, and she lemains peifectly veil 

[ 249 ] 



Jfydi oihotax and Anasajca 

20 Tins conibinnlioii is vciy Jreqncnl, nncl, I bclicvo, nijiy always bo 
onicd by llic Digitalis 

21 Dropsies in llic cliesi eitlici with oi willioiil anasaieons limbs, aie 
innch more curable limn those of the belly Probably because the ab- 
cloininal viscera aic moic fi’cqncntly diseased in the lattei than in the 
lormcr cases 

TnsanHi/ 

22 I apprehend this disease to be moic ricquenlly connected with 
scions offiision than has been commonly mmginod 


Ncidiuiis Cahnlom 

24 AVc have had sufficient evidence ol the efficacy of the Foxglove m 
removing the Dysnim and other symptoms of this disease, but piobably it 
IS not in these cases jncteiablc to the tobacco 

Ovainm Diop'^y 

25 This species ol encysted diopsy is not without difficulty distinguish- 
able fiom an ascites, and yet it is ncccssaiy to distinguish them, because 
the two diseases require diffcicnt ticatmont and because the piobability 
ol a cure is much grcatei in one than in the othci 

26 The oval Him diopsy is genoially slow in its progicss. Tor a con- 
sidciable tune the patient though somewhat emaciated, docs not lose the 
appearance ol health, and the iiiinc flows in the usual quantity It is 
seldom tlmt the piactitionci is called in caily enough to distinguish by 
the feel on which side the cyst oiiginatcd, and the patients do not attend 
to that cii eumslance themselves They gcnerallj^ menstiuate icgiilaily 
in the incipient state of the disease, and it is not until the prcssuic fiom 
the sac becomes vciy great, that the unnaiy sceietion diminishes In 
this species of diopsy, the patients, upon being questioned, acknowledge 
even fiom a pretty caily date, pains in the u])])ci and iiiiicr paits of the 
thighs, suuilai to those Avhich wonicu experience in a state of jucgnancy 
These pains aic foi a length ol tune gicatci iii one thigh than in the 
other, and 1 believe it will be found that the disease oiigiiiated on that 
side 

27 The ovarium dropsy defies the powci of medicine It admits of 
relief, and sometimes of a cuic, by tapping T submit to the considcia- 
tion of piactitioueis, how fai we may hope to cuic this disease by a seton 
or a caustic 

28 When tapping becomes nccessaiy, 1 always advise the adoption of 
the waist coat bandage oi belt, invented by the late vciy justly eclebiatcd 

»Sco tvn oilKlnal and valuable tioatisc by T>i l<’owloi. ontltlod, Mrdicnl ItopoW^ of the 
moots of ToVaooo - 



Di Monio, and described in the first volume of the Medical Essays I also 
en;)oin my patients to wear this bandage afteiwaids, fiom a pei suasion 
that It letards the letuin of the disease The piopei use of bandage, 
when the disoidei fiist discoveis itself, eeitainly contributes much to 
prevent its in ci ease 

Ova') ^u‘>n Di opsy W^fh A')iasai ca 

29 The anasaica does not appear until the encysted dropsy is very fai 
advanced It is then probably caused by weakness and piessure The 
Digitalis removes it f oi a time 


Phthisis Pulmonalis 


30 This IS a veiy inei easing malady in the present day It is no longer 
limited to the middle pait of life children at five years of age die of 
it, and old people at sixty oi seventy It is not confined to the flat-chested, 
the fair-skinned, the blue-eyed, the light-haiied, oi the sciophulous it often 
attacks people with full chests, blown skins, daik haii and eyes, and those 
in whose family no sciophulous taint can be traced It is certainly infec- 
tious The very stiict laws still existing in Itaty to pi event the infection 
from consumptive patients, were probabty not enacted oiigmally without 
a sufficient cause We seem to be appi caching to that state which fiist made 
such lestrictions neeessaiy, and in the fuither couise of time, the disease 
will piobably fall off again, both in viiulency and fiequency 

31 The youngei pait of the female sex aie liable to a disease veiy much 
lesembling a tiue consumption, and from which it is difficult to distinguish 
it, but this disease is curable by steel and bitters A ciiteiion of tiue 
phthisis has been sought for in the state of the teeth , but the exceptions to 
that lule aie iiumeious An unusual dilatation of the pupil of the eye, 
IS the most ceitain chaiacteiistic 

32 Sydenham asseits, that the baik did not moie certainly cure an 
inteimitteiit, than iiding did a eonsuiniitioii We must not deny the 
tiuth of an asseitioii, fiom such authoiity, but we must conclude that 
the disease was moie easily cuiable a centuiy ago than it is at present 

33 If the Digitalis is no longei useful in consumptive cases, it must 
be that I know not how to manage it, oi that the disease is more fatal 
than foimeily, foi it would be hard to deny the testimony cited at 
[page 241] I wish otheis would undeitake the enquiiy 

34 When phthisis is aeeoiiipamed with anasaica, oi when theie is lea- 
son to suspect hydiothoiax, the Digitalis will often lelieve the suffeiings, 
and piolong the life of the patient 


•Many a ears ago I communicated to mi fnend, Dr Percnal, an account of some trials 
of breathing fixed air m consumptne cases The results ivere published b> him in the 
second Vol of his xerj useful Essays Medical and Experimental, and ha\e since been 
copied into othei publications I take this opportunitj of acknou ledging that I suspect 
mi seif to haie been mistaken m the nature of the disease there mentioned to haie been 
ciiicd 1 belieie it was a case of ‘Toiiiica, and not a true Phthisis that lias cured The 


Vomica IS almost aluais curable The fixed air corrects the smell' Uie^rnatfer 
len shortli remoies the hectic feier - 


Ml patients not onlj inspire it 
Jars of the effenescing mixture constanUi at isork in their chambers 


but 


and 
I keep large 


[ 251 ] 



35 Many years ago, duimg an attendance upon Mi B , of a con- 

suniiitive family, and himself in the last stage of a phthisis , aftei he was 
30 ill as to be confined to his chambei, his breathing became so extiemely 
difficult and distiessmg, that he wished lathei to die than to live, and 
urged me warmly to devise some mode to lelieve him Suspecting serous 
effusion to be the cause of his symptoms, and he being a man of sense 
and resolution, I fully explained my ideas to him, and told him what kind 
of opeiation might affoid him a chance of lelief , foi I was then but little 
acquainted with the Digitalis He was earnest foi the opeiation to be 
tiled, and with the assistance of Mi Pariott, a veiy lespectable suigeon 
of this place, I got an opening made between the iibs upon the lowei and 
hinder pait of the tlioiax About a pint of fluid was immediately dis- 
charged, and his breath became easy This fluid coagulated by heat 

Aftei some days a copious iiuiuleiit disehaige issued ft om the opening, 
his cough became less tioublesome, his expeetoiation less copious, his 
appetite and stiength letuined, he got abioad, and the wound, which 
became veiy tioublesome, was allowed to heal 

He then undeitook a jouiney to London, whilst theie he became woise 

retuined home, and died consumptive some weeks aftei waids 

< 

Puet petal Anasatca 

36 This disease admits of an easy and ceitain cure by the Digitalis 

37 This species of diojisy may oiiginate fioni othei causes than child 
biith In the beginning of last Maich, a gentleman at "Wolveihampton 
desued my advice foi veiy laige and painful swelled legs and thighs He 
was a temperate man, not of a diopsieal habit, had gieat pain in his 
gioins, and attributed his complaints to a fall fiom his hoise Pie had 
taken diuretics, and the strongest drastic puigatives with veiy little 
benefit Considenng the anasaica as caused by the diseased inguinal 
glands, I oidered a common poultice and meiciiiial ointment to the 
groins, thiee grains of pulv foi Digitalis night and moining, and a cool- 
ing diuretic decoction in the day-time Pie soon lost his pain, and the 
swellings gradually subsided 

THE END 


[ 252 ] 



1788 

MATTHEW BAILLIE 

DESCRIPTION OF A CASE OF CONGENITAL 
DEXTROCARDIA WITH COMPLETE 
SITUS-TRANSVERSUS 





MATTHEW BAILLIE 

Prom the portrait collection of Northwestern University Medical School 


(Courtesy Petrolagar Lahoratones ) 


MATTHEW BAILLIE 

(1761-1823) 

IS of interest to note that Baillie wrote of the pertinent events concerning 
cJ his own life, and the manuscript, in his own handwriting, is now in the Library 
of the Eoyal College of Surgeons of England In 1896 it was printed in the “Prac- 
titioner ’ ’ This illuminating account forms the basis for our brief discussion 
Matthew Baillie was born in the Manse of Shots and County of Lanark, Scot- 
land, on October 27, 1761 His father, the Reverend Dr James Baillie was, accord- 
ing to his son, “a man of the most respectable character ’’ He ultimately became 
professor of divmity in the University of Glasgow 

Dorothea Baillie, the mother of Matthew, was a sister of William and John 
Hunter, the celebrated surgeons and anatomists, thus, early in life, Baillie received 
much genuine encouragement for his career m medicme 

Baillie ’s early education was obtained at Hamilton There he studied first at 
the English School and later at the Latin School At the age of thirteen, he be- 
came a student at the University of Glasgow There he continued his study of 
Greek and Latin for a period of five years, receiving a thorough trainmg in the 
classics and in philosophy 

In 1779, Baillie, acting on the advice of his uncle. Dr William Hunter, decided 
to enter the profession of medicine However, he had been appointed to an ex- 
hibition in Balliol College, Oxford, and for the next eighteen months he remained 
there, improving himself in the classics 

In 1780 he went to London to live with his uncle. Dr William Hunter, and to 
attend his lectures in anatomy and dissections at the Great Windmill Street School 
During the succeeding years he also studied chemistry, matena medica, and medicme 
under Dr George Fordyce (1736-1802), who was, for several years, the most popular 
lecturer in London on these subjects Baillie also attended the lectures on surgery 
given by his other uncle, John Hunter, and the lectures on midwifery which were 
given jointly by Dr Thomas Denman (1733-1815) and Dr William Osborne (1736- 
1808) 

Dr William Hunter died m March, 1783 He left Baillie a legacy of 5,000 pounds 
and a small estate in Scotland Baillie, believing that his uncle, John Hunter, had 
a better claim to the estate, ceded it to him Dr Hunter had arranged through his 
will that Baillie should succeed him as lecturer m anatomy, in association with Wil- 
liam Ciunberland Cruikshank (1745-1800) At the Great Windmill Street School 
Baillie continued as lecturer in anatomy for fifteen years, in spite of the irascibility 
of his associate Meanwhile, his private practice had mcreased and in 1799 he re- 
hnamshed his anatomic lectures 

Shortly after his uncle’s death, Baillie received the degree of Bachelor of Arts 
from Oxford University He also received the degree of Bachelor of Medicine m 
1786 and that of Doctor of JMedicine in 1789, both from Oxford University 

In 1787 he was appointed physician at St George’s Hospital and in 1790 he 
received bis fellowship in the Eoyal College of Physicians, London 

[ 255 ] 



Baillie, in 1791, was married to Sophia, the youngest of twin daughters of Dr 
Thomas Denman, under whom he had studied obstetrics This marnage resulted m 
the hirth of three children James, Elizabeth Margaret, and William Hunter 
Baillie 

One of Baillie ’s patients was the celebrated Dr David Pitcairn (1749-1809) 
When Pitcairn retired from the practice of medicme, because of ill health, he turned 
over much of his practice to Baillie 

Baillie ’s practice grew very rapidly and at length in order to attend all his pa- 
tients he found it necessary to work from 6 o’clock in the mommg until 11 o’clock 
each night This state of practice lasted for a period of twelve years and was 
ruinous to Baillie ’s health Soon he was obliged to confine his work to consultation 
In 1810, Baillie received the command of King George III to attend his daughter, 
the Princess Amelia, who died on November 2 of the same year This was the be 
ginning of his many attendances to the Boyal family, for he was soon appointed 
physician extraordinary to the King 

In the summer of 1823, Baillie ’s health again failed, presumably because of con- 
tinued overwork A severe cough developed, apparently the result of an mflam- 
mation of the trachea He died on September 23, 1823 A bust of him was made by 
Chantrey and placed in Westminster Abbey 

Baillie made important contributions to the medical literature In 1788 and in 
1789 he published two anatomic papers in the “Philosophical Transactions’’ of the 
Eoyal Society The first of these was in the form of a letter to John Hunter entitled 
“An Account of a Remarkable Transposition of the Viscera ’’ This early observa- 
tion of congenital dextrocardia with complete situs-transversus we are reprmting 
According to Pettigrew, cases of a similar kind were recorded by Winslow, Su: 
Astley Cooper, Dr Quain, Dr Watson, and others Baillie 's second paper to the 
Eoyal Society was communicated by John Hunter It was entitled “An Account 
of a Particular Change of Structure in the Hiunan Ovanum ’ ’ In 1790, presumably 
because of these publications, Baillie was elected to the Eoyal Society 

In the year 1793 he published the first edition of his “The Morbid Anatomy of 
Some of the Most Important Parts of the Human Body ’’ During Baillie’s lifetime 
this book went through several editions In order to illustrate the subject of morbid 
anatomy on a systematic plan, Baillie began to publish “fasciculi” of engravings 
Ten of these were published separately and in 1803 they appeared in book form 
A second edition of this work appeared in 1812 

During his later years, Baillie contributed several articles to the “Transactions” 
of the Society for the Improvement of Medical and Chirurgical Knowledge and to the 
“Transactions” of the Eoyal College of Phjraicians 

In addition to membership in the Eoyal Society of London and the Eoyal Society 
of Edmburgh, Baillie was an honorary member of the Eoyal College of Physicians 
of Edinburgh, a Fellow of the Eoyal College of Physicians in London, a member of 
the Medico-Chirurgical Society in London, and an honorary member of the Medical 
Societies of Erlangen and Bonn 


[ 256 ] 



OF A REMARKABLE TRANSPOSITION OF 
THE VISCERA* 

By 

MATTHEW BAILLIE 

N othing tends moie to illustrate the poweis and the wisdom of 
natuie than the immstigation of the structuie of animals We 
theie find a most wondeifnl delicacy of mechanism, and exquisitely 
adapted to a vaiiety of pin poses Tins howevei is not to be bettei seen 
by following natnie m hei common tiack than by observing her wander- 
ings In these she often shows more paitienlaily the extent of liei 
poweis, and throws light on her ordinary plans Such circumstances 
give impoitaiiee and value to the observation of singular phenomena 
The variety in animal stinctuie, an account of which is presented m this 
account, is a complete transposition in the human subject, of the thoracic 
and abdominal visceia, to the opposite side fiom what is natural It is so 
extraoidinaiy as scarcely to have been seen by any of the most celebrated 
anatomists, and indeed has been but very generally noticed at all The 
circumstance has been mentioned, but it has not been paiticulailj'’ de- 
scribed so as to make it thoioughly known, oi to establish its ceitamty 
It was hanging in the minds of many as doubtful, whether such a vaiiety 
did leally exist There is one cii cumstance that attends the account of 
the present case, Avhich has not always happened in the lecoid of 
singular phenomena, via that it has been examined by physicians and 
surgeons of the first leputation in this large town, and has been in some 
measure open to the gratification of public curiosity 
The person who is the subject of tins paper was a male, nearly 40 
yeais of age, somewhat above the middle statin e, and of a clean actne 
shape lie was brought foi dissection in the common way to Windmill- 
stieet On opening the cavity of the tlioiax and abdomen, the difterent 
situation of the Msceia was so striking as immediatelj’’ to excite the atten- 
tion of the pu])ils who iveie engaged in dissecting it I began immedi- 
ately to examine eieiy part of the change vith consideiable attention 
foi this purpose aftei desiimg a diauing to be made of the appearances 
as they u oi e found on opening the body, I next day injected it 
The mediastinum oi anteiioi dupliealuie of the pleiiia, separating the 
2 caMtics ot the chest fiom each othei, uas found to incline obliquely 

Lomlon IG iS3-lSS, 17S5-17G0 (abridged ISOS) (Original 78 

17SS ) 

[ 257 ] 



downwaids to the light side fully as much as it does commonly to the left 
side of the chest The peiicaidiiim too inclined obliquely to the right 
side On pressing it gently aivay fiom the lungs the phienic nerves 
came distinctly into view, in then common situation, but the right 
phienie neive ran moie obliquely, and was longei than the left The 
lung on the light side was divided by a single oblique fissuie into 2 lobes, 
having at the same time a deficiency opposite to the apex of the heart, 
and the lung on the left side was divided into 3 lobes, exactly contrary 
to what IS found in oidinaiy cases 

On opening the peiicaidium the apex of the heart was found to point 
to the light side nearly opposite to the 6th iib, and its cavities as well as 
large vessels weie eompletelj'’ tiansposed What aie commonly called 
the light auiicle and ventiicle weie situated on the left side, and the 
left auiicle and ventiicle on the light The inilmonaiy aiteiy ascended 
towaids the light side of the chest The aoita was also diiectmg its 
arch to the right, and the vena cava supeiioi, as well as infeiioi, weie 
seen opening into then auiicle on the left side of the spine Theie was 
nothing lemarkable in the size oi geneial figuie of the heait On the 
outside of the peiicaidium the tiaiisposition of the largei vessels was 
veiy sti iking The longei subclavian vein was passing fiom the left side 
obliquely to the light before the blanches which aie sent off fiom the arch 
of the aoita The left carotid and subclavian aiteiies weie found to 
aiise fiom the aicli of the aoita by one common tiuiik, the light caiotid 
and subclavian sepaiately 

In the duplicature of the pleuia behind, oi what may be called the 
posteiioi mediastinum, theie was a change coiiesponding to what we 
have alieady desciibed The descending aoita was found passing on the 
light side of the spine The oesophagus was befoie it, inclining moie 
and moie to the right towards its lowei extremity, and it at length 
peifoiated the diaphiagm somewhat on the light side of the spine* 
The thoiacic duet was seen in the middle between the descending aoita 
and vena azygos, in some places foiming a plexus of small branches, in 
another dividing itself into 2 blanches, which afteiwaids le-united in 
a common trunk, and at length climbing up to teiminate in the angle 
between the jugulai and subclavian veins on the right side of the body 
The lecurient neive of the parvagum on the light side passed lound the 
beginning of the descending aoita, and on the left passed loiind the 
common trunk of the caiotid and subclavian aiteiies The large inter- 
costal neives being exactly undei the same eiieumstances on each side. 
It was impossible theie could be any tiansposition m them It appeals 
then fiom the foregoing description, that every thing admitting of such 
a change was completely tiansposed in the thoiax 


»ThP vena azvEOs ^\as on the left sjcle of the spine opening in the common wai mto 
the vena cava superior, which we formerly mentioned to be also transposed in its s 
tion — Orig 

[ 258 ] 



The liver was situated m the left hypoehondiiac legioii, the small lobe 
being towaids the light, and the gieat lobe in the left side The liga- 
ments uniting it to the diaphragm coiiesponded to this change, the light 
transveise ligament being longei, and the left being shoiter, than usual 
The suspeiisoiy ligament could undeigo little change, except being 
pushed to the left side along with the livei On pressing upwaids the 
liver, so as to exhibit its posterioi and iiiidei suiface, the gall bladdei was 
seen on the left side preserving its proper relative situation to the great 
lobe of the livei, and the vessels of the portae were found on dissection to 
be transposed eoi responding to the change of eiicumstances The 
hepatic alter y was found climbing up obliquely from the right towaids 
the left, before the lobulus spigelii, and entered at the portae into the 
substance of the livei by two oi three branches on the light of the other 
vessels The ductus communis eholidoehus was on the left of the other 
vessels, being formed from the ductus hepaticus and ductus cysticus in 
the common way, and it passed obliquely downwards on the left, to 
terminate in the duodenum What was most remarkable, it terminated 
in the fore pait of the duodenum The vena poitaium passed behind 
the hepatic artery and ductus communis eholidoehus, ascending obliquelj’- 
towaids the left side 

The spleen was situated in the light hypochondriac region, adheiing 
to the diaphragm in the common way There were 3 spleens, nearly of 
the size of a pullet’s egg, found adheiing to the larger spleen by shoit 
adhesions, besides 2 other still smaller spleens which were involved in the 
epiploon at the gieat end of the stomach The pancreas was found on the 
light side behind the stomach, running obliquely from the spleen to the 
curvatuie of the duodenum, and had its duct entering in common with 
the ductus communis eholidoehus into the cavity of that intestine The 
splenic vessels weie passing along the uppei edge of the panel eas to the 
light side, coiiespondmg to the change of situation in the pancreas and 
spleen 

The stomach was situated on the right side, partly hid by the small lobe 
of the livei passing to the left, and teiminating in the pyloius, rathei 
on the left side of the spine The duodenum took a most singulai course , 
it fiist passed to the light side, behind the small end of the stomach, it 
then turned on itself, towaids the left side, it afteiwaids took its proper 
sweep to the light side, passing behind the supeiioi mesenteiic aiteiy and 
mesaiaica iiiajoi vein The mesenteiy began to be foimed on the light 
side, instead of the left, as m ordinaiy cases The ilium teiminated in 
the gieat intestine on the left side, and there was in it a divei tieuliun of 
consider able size, a lusus not unfiequently oceuiiing The caecum was 
situated on the left psoas niagnus and iliacus inteiiius muscles The 
tiansieise aich of the colon passed from the left to the light side of the 
body, and the sigmoid flexiue eiossed oaci the light psoas, to get into 

[ 259 ] 



the cavity of the pelvis The kidneys had then vessels transposed, the 
renal capsules had undeigone no change, as no variety could be pioduced 
by a transposition 

The aorta passed between the ciuia of the diaphiagm into the cavity of 
the abdomen, and adheied in its eouise to the spine on the right side of 
the vena cava infeiioi Its blanches weie directed in then couise coi- 
responding to the peeuliai situation of the visceia The splenic and 
coronary aiteiies weie passing to the light side, and the hepatic arteiy 
obliquely to the left The supeiioi and nifeiioi mesenteiic aiteiies weie 
directed to the light side Theie was no change in the speimatic aiteiies, 
any transposition m the testicles, if such a thing could take place, not being 
capable of affecting them The lumbai aiteiies could also undeigo little 
change, except that the left lumbai aiteries must necessarily, fiom the 
peculiar situation of the aoita, be the longest The vena cava inferior 
perforated the tendinous portion of the diaphragm, and adheied in its 
couise to the spine on the left side of the aorta 

The light emulgent vein was much longer than usual, passing from the 
light kidney before the aoita to terminate in the vena cava supeiioi , and 
the left emulgent much shoitei, passing from the left kidney to the vena 
cava, which was situated on the left side of the spine The light spermatic 
vein was found to open into the light emulgent, and the left into the 
vena cava infeiioi, about an inch uiidei the left emulgent The vena 
portarum was changed from its natuial couise, passing obliquely up- 
wards to the left side, and its large blanches, viz the A’-ena splenica, 
mesaiaiea major and minor, Aveic all directed toAvaids the light side 
of the spine There was no change in the intercostal neiA’’e Avithin the 
caAuty of the abdomen, noi does it seem to be capable of being affected 
by any tiansposition of parts We see then, that there Avas a complete 
transposition of the abdominal Ausceia, each of them piesenang its 
proper lelatiA'-e situation to the otheis In the biain, organs of sense, of 
generation, the muscles, and blood A'^essels of the extremities, Avas found 
nothing remaikable 

The person seems to have used his light hand in preference to his left, 
as IS usually the case, AAdiich AA^as readily discovered by the greater bulk 
and hardness of that hand, as well as the gieatei fleshiness of the aim 
It was not indeed to be expected he should be left handed The person, 
while aliAm, was not conscious of any uncommon situation of his heart, 
and his bi other has his heart pointing to the left side as in ordinal y 
cases Indeed, there was little leasoii to expect that we should meet 
with any thing paitieulai in the account of his life His health could 
not be affected by such a change of situation in his viscera, noi could 
there anse from it any peculiar symptoms of disease Still less could 
there be any connection between such a change and his dispositions, or 
external actions He might have known that his heait Avas directed to- 

[ 260 ] 



waids the right side, but it we coiisidei how little evety peisoii, espe- 
cially those of the lowei class, aie attentive to ciicuinstances not veiy 
palpable, it was scdicely to be exiiected he should know of it 
Notwithstanding the geneial similaiity of paits in the same species of 
animals, there is no reason why natuie should not sometimes deviate fiom 
hei oidinaiy jilans Accoidinglj’' we find theie is much variety in animal 
structuie, but this does not commonly affect the animal functions Under 
this lestiiction the variety is so great m the aj)peaianees of every part 
of an animal, that it is almost impossible to examine any 2 animals of 
the same species without leniarkmg many diffeiences In the bony 
compages of an animal we find little vaiiety in the extiemities of bones 
wiieie theie is the appaiatus of a ^oint, because a paiticiilai shape is 
best adapted to a paiticulai kind or latitude of motion In other parts 
of the bones, where a di:ffeience of features is not irrateiial, theie is great 
variety, as in the foianiina, depiessions, iidges, and sutures of bones 
The same general rule will a]rply to variety nr muscles The piiireipal 
object IS a eeitam nisei tion iieai a joint, so as to give a deteimined direc- 
tion of motion With respect to such insertions, theie is, compai atively 
speaking, little variety, but there is a great difference in the bodies and 
connections of muscles, which have no share in the regulation of the 
motion 

There is no part of an animal where there is a greater latitude of 
variety than nr the distiibution of blood vessels The reason of it is 
very obvious The only object in the distribution of blood vessels is, 
to cany blood to every part of the body and bung it back to the heart 
The parts of an animal, in order to be supported, must be visited bj'' 
successive changes of fiesh blood, but it surely cannot be an object of 
importance whether the blood passes by one route oi anothei Hence the 
variety of lilood vessels is extremely great Still, however, there is a 
method nr the deviations of nature, — so that they may be marked or 
noted, the same varieties occuiiing in different animals 

It cannot be at ail niipoitant to the function of a viscus, whether it be 
in one mass, or nr separate portions The structuie being the same, the 
same action will take place Hence we often find the two kidneys joined 
together, forming one mass, and not unfiequently two or three spleens, 
besides tlie common one Neither can it be important whether a viscus 
should ah\ aj s be of tlie same shape, because its functions do not depend 
on shape, but on stiuetuie we find aecoidingly, in this particular, much 
raiiety 

There are many of the viscera nhich aie connected togethei in their 
functions oi by the junction of large blood ressels, in such a way as to 
lequire iieailv the same lelatne situation among themsehes This be- 
comes also uccessai V m oulei to picserrc the general shape of the animal 
Aecoidiiurlv ne find that nhen anv imjioitant mscus is changed in its 

[ 2<>i ] 



situation, it affects the situation of othei viseeia, lequiimg in them a 
similar change We saw in the peison who is the subject of tins paper, 
that a change in the situation of the heart and livei was accompanied 
with a change of situation in the stomach, spleen, pancieas and in short 
the whole abdominal viseeia This-, howevei, is a gi eat deviation in 
natuie, foi it is nothing less than changing almost the whole vital system 
in an animal, and therefoie, it laiely happens In such a change it does 
not appeal that the functions can be affected, as they depend on struc- 
tuie and situation, which are both pieseived Hence the person who is 
the subject of this papei aiiived at the age of matuiitj'- and might have 
continued to live to an extieme old age Tlie human machine might 
have been constructed in this waj"- geneially, and undei such circum- 
stances, what IS now called the natuial situation of paits would have been 
as singular as the piesent phaenomenon 

There appeals to be less variety in the neivous system of animals of 
the same species, than in most paits of the body Theie is seaicely any 
diffeience in the appearance of the biain, and much less in the distribu- 
tion of the nerves than of the blood vessels There is also little variety in 
the oigans of sense perhaps the mechanism in both these is nicer, so 
that a consideiable deviation would inter feie with then peculiar func- 
tions The most eominon great deviations which natuie produces in the 
stiuctuie of an animal, aie various kinds of monstrosity, by which the 
animal becomes often unfit foi continuing its existence Why nature 
should in its greatei deviations fall into a veiy imperfect formation, 
much below the standard of her common woik, does not appeal veiy 
obvious It seems that theie might have been many vaiieties where the 
functions could have been pieseived Pei haps it is with a view to check 
the inopagation of great varieties, so as to jneseive a uiiifoimity in the 
same species of animals 

It has been much agitated, whethei monstrosities depend on the 
original formation, oi aie produced aftei wards in the gradual evolution 
of an animal This does not appear to be a question of much im- 
poitanee, noi peihaps can it be absolutely detei mined But on the whole 
it IS moie reasonable to think that the same plan of formation is con- 
tinued from the beginning, than that at any subsequent period there is 
a change in that plan It may be observed, that it is exactly the same 
cieative action which produces the natural structure, or any deviation 
from it, foi in cases of deviation the action is either earned too far, 
ceases too soon, or is diveited into uncommon channels This will ex- 
plain the various kinds of monstrosity from redundancy, deficiency, or 
transposition of parts 


[ 262 ] 



1794 

record 




JOHN HUNTER 

(1728 1793) 


“In the history of human “progress there appeals vow and then a thundeiholt, 


the thunderholt of suigeiy is John Huntei ” 


— William Bojd 


and 


“Not Oxford with its intellectual store 
Of Greek and Latin, but the open space 
Of the wide firmament foi him, to face 
Nature herself and Universal Law 
He entered Truth’s stout stronghold at the door 
And, step by step, climbed up, with measured pace, 
Until he reached a high embattled place 
Where he remained and will, for evermore ’ ’ 


— T W Parry 


^OHN HUNTER was bom at Long Calderwood, in the parish of East Kilbride, 
P / Lanarkshire, Scotland, on February 13 or 14, 1728, the youngest of ten children 
Two of his brothers, James and William Hunter, also became physicians His 
elder brother, James, died at the beginning of a most promising career, and to William 
fell the task of aiding John in an unparalleled career in medicine 

At the age of seventeen John Hunter was sent to live with his brother-in-law, a 
Mr Buchanan, where he developed great mechanical skill as a carpenter in Buchan- 
an’s workshop During this time his brother, William, had made a very successful 
start in the practice of medicine, and at the age of twenty John Hunter decided that 
he, too, would have a medical career 

He therefore wrote his brother William in London and offered his services as an 
assistant in William Hunter’s dissecting laboratory His offer was accepted and 
while in his brother’s tutelage he was so successful that the next year he was to 
direct the dissections of the medical students 

Not long after he came to London, Hunter was introduced by his brother to the 
famous English surgeon, William Cheselden He soon became a student of Cheselden, 
under whom he worked at Chelsea Hospital durmg the summer months of 1749 and 
1750 On Cheselden ’s retirement in 1751, John Hunter became a surgical student 
at St Bartholomew’s Hospital There he worked under the distinguished surgeon, 
Percival Pott 

In 1753 Hunter entered St Mary’s Hall, Oxford, as a student, at the suggestion, no 
doubt, of his brother, William There he began to study the classics, but after a 
trial of two months dropped his course and determmed to remam within the realm 
of surgery In 1754 he became a surgical student at St George’s Hospital Two 
years later he served there as house-surgeon 

In 1754, Hunter after makmg several dissections discovered the method of con- 
nection between the placenta and the uterus This discovery twenty-five years later 
(1780) was to provoke a bitter public quarrel between the two brothers over the 
question of prionty, and it is to be regretted that it was to dissolve their friend- 
ship Both of the Hunters disputed with the Monros over priority in anatomic 
discovenes and later with Pott on the true nature of congenital hernia 

•SiiKiKnl Pnthnloou oil -1 laas p IT 


r 205 ] 



In 1759 Huntei, having served a period of ten years in the study of human 
anatomy, in order to understand more clearly the human body and its functions, 
began the study of comparative anatomy Because he worked very hard his health 
suffered and he was advised to seek the curative effects of a warmer climate On 
this account he applied for an appomtment with the army and was immediately 
made a staff surgeon 

During the Seven Years’ War he accompanied the Bntish expedition to Belle Isle 
in 1761 During that siege he found ample opportunity to treat gunshot wounds, a 
procedure for which he was later to become renowned Wliile he was thus engaged 
he found time to conduct investigations in experimental physiology He studied the 
digestion in lizards and snakes during hibernation and among other things, the 
faculty of heanng in fishes 

By 1763 the war was terminated and Hunter returned to London In order to in- 
crease his income he decided to teach anatomy in private classes He conducted 
classes in anatomy for several years During his spare time he continued his 
anatomic and physiologic mvestigations To obtain specimens for this research he 
obtained the bodies of animals that had died in the zoos of London and elsewhere 
He also purchased rare animals, when such a course was possible, spending money 
he could ill afford 

In 1767 Hunter was elected a fellow of the Eoyal Society His election probably 
was the result of recognition of his devout interest in comparative physiology, an 
interest that had not been shown by the publication of original investigations, for 
he had not as yet begun his publications Scientists in general in London already 
knew of his rapidly growing anatomic museum which, one day, was to become of 
national significance 

Hunter was appointed surgeon to St George’s Hospital in 1768, and soon after- 
wards he was chosen a member of the Corporation of Surgeons Thereafter he ob 
tamed pupils on more advantageous terms Among the most renowned of his stu- 
dents, according to Garrison, were Jennei, Astley Cooper, Abernathy, Clme, Clift, 
Parkinson, Blizard, Home, Alanson, Wnght Post, and Physick 

In 1771, Hunter published the first part of his medical classic, “The Natural 
History of the Human Teeth ’ ’ This was followed in 1778 by the second part, * ‘A 
Practical Treatise on the Diseases of the Teeth ’ ’ According to Garrison, Hunter 
was the first to study the teeth in a scientific manner and the first to recommend com- 
plete removal of the pulp before filling them 

Hunter’s marriage to Miss Home, sister of Sir Everard Home, took place m 
July, 1771 They had four children, two of whom died when very young In 1772, 
Hunter, being persuaded by Sir John Pringle, communicated his first paper to the 
“Philosophical Transactions’’ of the Royal Society The work concerned the diges- 
tion of the stomach after death In the fall of this yeai Sir Everard Home, his 
brother-in-law, became his student and afterward was to act as his assistant 

In 1776 Hunter was appointed surgeon-extraordinary to the King That same 
year he was invited to deliver the Croonian Lectures before the Royal Society For 
the subject of these lectures he chose “Muscular Motion’’ In 1778 he was ap- 
pointed surgeon to the new naval hospital at Plymouth The Royal Society of 
Belles-Lettres of Gothenburg elected Hunter a fellow in 1781, and in 1783 he was 
elected to membership in the Royal Society of Medicine and the Royal Academy of 
Surgery of Pans 

Fordyce, Hunter, and others were instrumental in founding in 1783 the Society 
for the Improvement of Medical and Chirurgxcal Knowledge Although this society 
had but a brief life, many valuable papers are included in its “Transactions ’’ 

[266] 



In 1783, Hunter procured at a cost of 500 pounds the “kidnapped” body of the 
famous Irish giant, Byrne or Ohrien He disarticulated the skeleton and it occu- 
pied a prominent place in his Museum of Natural History In the same year the 
Eoyal Society conferred upon him the Copley medal in recogmtion of his important 
discoveries in natural history 

In 1785, Hunter began to suffer from recurring attacks of angina pectoris He, 
therefore, spent a holiday at Bath and during his convalescence entrusted his medical 
practice to his brother-in-law, for whose ability he had a high regard In December 
of that year Hunter, feeling somewhat refreshed from his stay at Bath, established 
his famous operation for the cure of aneurysm This consisted in tying the artery at 
a distance high in the healthy tissues by a single ligature 

Hunter was appointed deputy surgeon-general to the army in 1786 That same 
year he published his work on venereal disease i Believing that syphilis and gonor- 
rhea were identical he inoculated himself with spirochetes and subsequently thought 
he observed the symptoms of both diseases This confirmed him in his belief that 
both diseases were identical This erroneous conception was later demolished by 
Philippe Eicord (1800-1889) who proved the autonomy of these diseases (1831-1837) 
Hunter did, however, correctly differentiate between hard chancre and chancroid 
ulcer 

In 1786 Hunter also published his important work, “Observations in Certain 
Parts of the Animal Oeconomy,” which consisted of a revision and enlargement of 
many of his papers originally published in the “Philosophical Transactions” of the 
Eoyal Society 

In 1792, Hunter transferred his surgical lectures to his brother-in-law, Home, and 
devoted much of his time to the completion of his famous work, “A Treatise on the 
Blood, Inflammation and Gunshot Wounds” This was not published until 1794, 
about a year after Hunter’s death From Home’s account of the life of Hunter, 
which prefixes this work, we are reproducing Hunter’s classic descnption of his 
own fatal illness, angina pectoris, as detailed to his brother-in-law 

Hunter had said that his “life was m the hands of any rascal who chose to annoy 
and tease him ’ ’ And there can be no doubt but that the violent disagreements he 
had with his colleagues at St George’s Hospital hastened his death, which occurred 
on October 16, 1793, following a meeting of the board of governors of St George’s 
Hospital, at which a colleague had directed some disparaging remarks to him 

The great monument to the fame of John Hunter is the Hunterian Museum of 
13,000 specimens purchased by Parliament some time after his death for 15,000 
pounds, a fraction of its cost, and presented to the Corporation of Surgeons, soon 
afterward to become the Eoyal College of Surgeons 


a fJcofiM on the itJicJta/ rfiicost. 


[ 267 ] 


’Humor, Jolin 


Hoiulon 17S,G 39}> pn 



A 


TREATISE 

Cjyf 

THF. BLOOD, 

INFLAMMATION, 

AND 

GUN-SHOT WOUNDS, 

BY THF LATE 

JOHN HUNTER. 


TO WHICH JS TREnVED . 

• ♦ 

A SHORT ACCOUNT OF THE AUTHOR'S LIFE, 

HY HIS DROTHtR-lN-LAW, 

EVERARD HOME 


JH TWO VOLUMES, FROM THE LONDON QUARTO. 

VoL. I 


THILADELPHIA 

Published by THOMAS BRADFORD, printer 

BOOK-SELLFR CS’ STATIONER, 

No. 8, 

Sculh FroJii-Si) cct, 

1796. 






A TREATISE ON THE BLOOD, INFLAMMATION, 
AND GUN-SHOT WOUNDS* 

BY THE LATE JOHN HUNTER 

A Short Account of the Author’s Lifer 
By His Brother-In-Law 
Everard Home 

M b hunter was a very healthy man for the fiist foity yeais of his 
life, and, if we except an inflammation of his lungs in the year 
1759, occasioned most probably by his attention to anatomical pm suits, 
he had no complaint of any consequence during that peiiod In the 
spiing of 1769, 111 his foity-fiist yeai, he had a regulai fit of the gout, 
which 1 etui lied the three following spiiiigs, but not the fourth, and in 
the spiing of 1773, having met with something which veiy foicibly 
afCected his mind, he was attacked at ten o’clock in the foienoon with a 
pain in the stomach, about the pyloius, it was the sensation peculiar to 
those paits, and became so violent that he tried change of position to 
pioeuie ease, he sat down, then walked, laid himself down on the carpet, 
then upon chaiis, liut could find no lelief , he took a spoonful of tinctuie 
of ihubaib, with thiity diops of laudanum, without the smallest benefit 
While he was walking about the loom he cast his eyes on the looking 
glass and obseiied his countenance to be pale, his lips white, giving the 
appearance of a dead man This alaimed him, and led him to feel foi his 
pulse, but he found none in eithei aim, he now thought his complaint 
seiioiis, seveial physicians of his acquaintance weie then sent foi, Dr 
William Huntei, Sii Geoige Bakei, Di Huck Saiindeis, and Sii William 
Foidyce, all came but could find no pulse, the pain still continued, and he 
found himself at times not bieathing Being afiaid of death soon taking 
place if he did not bieathe, he pioduced the voliintaiv act of bieathing, 
by voikmg his lungs In the ponei of the mil the sensitne principle, 
with all its effects on the machine not being in the least affected bv the 
complaint In this state he continued foi thiee-qiiaiteis of an hour, in 
which time fiequent attempts weie made to feel the pulse, but in vain, 
howc\ei at last, the pain lessened and the pulse letuined although at 
fust blit faintlv, and the involuntaiy bieathing began to take place, 
while in this state he took Hadeiia biamh. gingei etc but did not be- 

‘TIk? Otet IlnpIKli tilition i«! inibli>!lie<l in liSj o ni' icpiintinir fiom tlio ar«t 
\m»ri( in oilition imblished in 17‘>G — F \ W I'l-lO 
tPp wh-liii 


{ if'*' 1 



lieve them of any seivice, as the letuin of health was veiy giadual, in 
two houis he was peifectly lecoveied 

In this attack theie was a suspension of the most mateiial involuntaiy 
actions, even involuntaiy bieathing was stopped, while sensation with 
Its consequences, as thinking and acting with the will, weie peifect, and 
all the voluntary actions weie as stiong as befoie 

Quere What would have been the consequence of his not having 
breathed by means of the voluntaiy muscles? It stiuck him at the 
time that he would have died, but we cannot suppose that would have 
been the consequence, as bieathing most piobably is only neeessaiy foi 
the blood while ciiculating, and as the cii dilation was stopped, no good 
could have aiisen fiom breathing 

When he was at fiist attacked, the inilse was full and eight ounces of 
blood were taken awaj^, but this did not appeal to be of seiviee, the 
day following he was ciqiped between the shouldeis and had a large 
blistei applied upon the pait, he took an emetic, and sevexal times 
purging medicines and bathed his feet in waim watei, but nothing ap- 
pealed to be of the least use Tlie puiging and vomiting distressed him 
greatly, for both the stomach and intestines weie so iiiitable that less 
than half the usual quantitj’’ had the desiied elfeet He took some 
James’s powdei,’^ and diank some white wine vhey on account of the heat 
in the skin, especially in the feet and hands, which took it off and gai e 
him for the first time a comfoi table feel At the end of ten days all his 
ideas of his piesent state became moie natuial, the stiange deception con- 
cerning his own sue was in pait collected, and the idea of suspension in 
the ail became less, but foi some time aftei, the file appeared of a deep 
purple red When he got so well as to be able to stand ivithout being 
giddy, he was unable to walk without suppoit, foi his own feelings did 
not give him information lespecting his centie of giavity, so that he was 
unable to ballance his body, and pi event himself fiom falling 

He gradually lecoveied fiom this state, and as soon as he was able 
went to Bath, wheie he staid some time and diank the waters, which 
were thought to be of seivice to him , but did not stay long enough to 
give them a fair trial, he letuined to town much bettei, and in a few 
weeks got quite well Fiom this peiiod to 1785, he had no paitieulai in- 
disposition, but ceitainly did not enjoy perfect health, foi in 1785, he 
appeared much altered in his looks, and gave the idea of having giowii 
much older than could be accounted foi fiom the numbei of yeais which 
had elapsed 

About the beginning of Apiil, 1785, he Avas attacked with a spasmodic 
complaint, which at fiist Avas slight, but became aftei ivaids veiy Auolent, 

»James s powder contained 1 part of antiroonious oxide and 2 parts of calcium phos- 
phate and was used as a diaphoretic — F A AA'^ 1940 

[270 ] 



and teiminated in a fit of the gout in the ball of the gieaf toe, this, like 
his other attacks, was bi ought on by anxietj^' of nijind, the fiist symptom 
was a sensation of the muscles of the nose being in action, but whether 
they leally weie oi not, he was nevei able to deteimine, this sensation 
letuined at mteivals foi about a foitmght, attended with an unpleasant 
sensation in the left side of the face, lower jaw, and throat which seemed 
to extend into the head on that side and down the left arm, as low as the 
ball of the thumb, where it terminated all at once, these sensations were 
not constant, but letuined at iiiegulai times, they became soon more 
violent, attacking the head, face,, and both sides of^the lower jaw, giving 
the idea that the face was swelled, paitieulaily the cheeks, and sometimes 
slightly affected the right aim Aftei they had continued foi a fortnight 
they extended to the sternum, pioducmg the same disagieeable sensations 
there, and giving the feel of the sternum being diawn backwards to- 
ward the spine 

I was with him during the whole of this attack, and nevei saw any- 
thing equal to the agonies he suffered, and when he fainted away, I thought 
him dead, as the pain did not seem to abate, but to cany him off, having 
first completely exhausted him 

He then fell asleep for half an houi, and awoke with a confusion in 
his head, and a faint recollection of something like a deliiium, this went 
off in a few days 

The affections above-described weie, in the beginning, readily brought 
on by exercise, and he even conceived that if he had continued at rest, 
they would not have come on , but they at last seized him when lying in 
bed, and in his sleep, so as to aivaken him, affections of the mind also 
brought them on, but coolly thinking or reasoning did not appear to have 
that effect Wliile these complaints were upon him, his face was pale, 
and had a conti acted apireaianee, making liim look thinner than ordinary, 
and after they went off his colour leturned, and his face recovered its 
natural appearance On the commencement of the complaint, he suspected 
it to be iheumalism, and applied electiicity to his arm, which took it off 
foi the time onh , he then, for two or thiee nights successively, took three 
grams of James’s powder, witliout anv abatement of the symptoms, he next 
had lecouise to the eamplioiated julep, both at the commencement of the 
spasm, and "while it vas upon him, but obtained no relief, lie tried Hoff- 
man’s anodjme liquor, in the dose of a tea-spoonful, and not finding it to 
ansvei alone, joined to it the eamplioiated julep, but the spasms seemed 
to be moie Molent, one night he took twenty drops of thebaic tincture, 
which made his head confused all the following dav, but did not at all abate 
the spasms, the following dav he took two tea-spoonfuls of the bark, which 
heated him, and ga^e him a head-ach, thiist, and diraess of his mouth, 
which pie\eiitcd his eoiitinuiiig it At the desiie of Dr David Pitcairn, 

[ 271 ] 



iie took the powdei of valeiiaii, ali ounce a day, wliicii seemed ioi the hist 
two days to lemove his spasms, but the-\ letiiiiied on the thud with moie 
violence than usual, especially one evening at the Royal Society, Avhicli in- 
duced him to lea-^e off the valeiian, and he bathed his feet on going to bed 
in warm watei, mixed ivith half a pound of fioui of miistaid, and took a 
tea-spoonful of tinctuie of iliubaib m gmgei-tea, also woie woisted stock- 
ings all night 

On Friday moining, the twentieth of May, between six and seven o’clock, 
he had a violent spasm, attended with most violent ei notations of wind 
from the stomach foi neaily a quaitei of an hoiii Di Pitcaiin, who was 
sent foi upon this occasion, asked him, if tlieie was any distress upon his 
mind that had bi ought on tins attack, and he confessed his mind to have 
been much hariassed, in consequence of having opened the body of a per- 
son who died fiom the bite of a mad dog, about six weeks befoie, in doing 
which he had wounded his hand, and foi the last foitnight his mind had 
been in continual suspense, conceiving it possible that he might be seized 
with symptoms of hydiophobia This anxiety piecing upon his mind foi 
so long a time, theie is eveiy leason to believe was the cause of the piesent 
attack and piobably had also bi ought on the formei ones, which weie all 
aftei the accident which liad impiessed his mind witli this hoiiible idea 

At the desiie of Di Pileaiin, he took at two doses in the foienoon, ten 
giains of asafoetida, and thiee giains of opium, and in the afternoon 
fifteen of asafoetida, and one of opium , in the evening he had a liead-ach, 
which was supposed to be biought on by tlie opium, liis bowels veie loaded 
and oppiessed with wind, and lie endeavouied in vain to proem e a motion 
by laxative elysteis, although lepeated, and ten giains of jalap weie taken 
by the mouth, he passed a veiy lestless night On Satin day moining 
he was visited by Sii Geoige Bakei, Di Waiien, and the late Di 
Piteaiin he lepeated the asafoetida twice in the couise of the day, and 
two spoonfuls of the following mixtuie weie taken eveiy horn, ivithoiit 
pioducmg a motion till about half an houi aftei the whole was used 

Infusion of senna, six ounces, 

Tinctuie of senna, one drachm and a half. 

Soluble taitar, thiee diachms 
M 

111 the afternoon he had aiiothei evacuation, soon aftei which, the most 
violent attack of spasm which he had expeiienced, came on, nothing 
was attempted inteiiially duiiiig the attack, which lasted two houis, a 
bladdei of hot watei was applied to the heait, and afterwaids to the 
feet, without any effect 

The asafoetida was now left off, and this evening he began the oleum 
siiccmi in saline di alights fifteen diops eveiy six houis On Sunday 
moining he continued the oleum sueeini, but the saline di aught was 
changed to cinnamon-watei, and a laige blistei was put upon the back 

r 272 ] 



close to the neck, he continued pietty fiee fioin spasm On Monday the 
lilistei was taken off, and the oleum succini continued , but about nine 
o’clock at night he had thicatenings of spasm, with head-aeh, and the 
feel of a load in his bowels, he had a pain in the left side and legion of 
the stomach, with violent eiuctations of wind fioiii the stomach, which 
lasted about two houis, he took thebaic tmctuie, twenty-five diops, m the 
waim tmctuie of ihubaib, and afteiwaids some baunie de vie, but the 
eiuctations continuing, sinapisms were applied to the feet, after which they 
ceased, and the sinapisms were so troublesome that he had them taken 
off five houis aftei they weie applied On Tuesday iiioinmg he felt him- 
self easier, the oleum succini was contmued, five diops of laudanum 
being added to each dose, m the evening he bathed his feet in waim 
water, to clean them fiom the sinapisms, and both the gieat toes appealed 
a little inflamed, and very tendei , they weie moie painful after being 
bathed, and weie very ti oublesome all night On Wednesday moiiimg 
the inflammation and swelling in the gieat toes appeared evidently to 
be the gout, and the pain continued veij’’ acute till Thiiisdaj'’, when it 
began to abate and on Fiiday ivas veiy much diminished he contmued 
the oleum succini on Wednesday, and took a bolus of aiomatic species 
before each dose, but on Piiday the oleum succini made him sick, and 
was left off On Saturdaj^ he began the baik m tincture and decoction 
with the species aiomatieae, Sunday contmued the baik, and having 
eructations and flatulencies aftei his meals, he was oideied eveiy daj’' 
before dnmei, ihubaib fifteen giams, gmgei ten giams, in a bolus He 
had no spasm aftei Monday the thiitieth of May, he howevei had 
tlireatenmgs, or slight sensations, smiilai to those which pieeeded the 
spasms, and occasional eiuctations Although evidently relieved fiom 
the Molent attacks of spasm by the gout m his feet, yet he was fai fiom 
being fiee fiom the disease, foi he was still subject to the spasms, upon 
exeicise oi agitation of mind, the exeieise that geneially bi ought it on, 
was walking, especially on an ascent, eithei of staiis oi using giound, 
but nei ei on going down eithei the one oi the othei , the affections of 
the mind that bi ought it on veie pi incipallj’' anxiety oi angei it nas 
not the cause of the anxiety, but the quantitj’- that most affected him , 
the anxiety about the hiving of a swaim of bees bi ought it on, the 
anxietv lest an animal should make its escape befoie he could get a gun 
to shoot it. hi ought it on, cAen the heaimg of a stoiy m vhieh the mind 
became so much engaged as to be mteiested m the event, although the 
])aiticulais ueie of no consequence to him, uould bung it on, angei 
In ought on the same complaint and he could concene it possible foi that 
passion to be canied so fai as totallv to depine him of life but uhat uas 
\eiv extiaoidinai V the moie tendei passions of the mind did not pioduce 
It, he could lelate a stoic uhich called up all the finer feelnnrs as com- 
passion admnation foi the actions of giatitude in otheis so as to make 

t 27S 1 



him shed teais, yet the spasm was not excited, it is extiaoidniaiy that he 
eat and slept as well as evei, and his mind was in no degiee depiessed, 
the want of exeieise made him gioiv nmisiially fat 

In the autumn 1790, and in the spung and autumn 1791, he had moie 
seveie attacks than duiiiig the othei peiiods of the yeai, but of not moie 
than a few liouis duiation in the beginning of Octobei, 1792, one, at 
which I was pieseiit, was so violent that I thought he would have died 
On Oetobei the 16th, 1793, when in his usual state of health, he ivent to 
St Geoige’s Hospital, and meeting with some things which nutated Ins 
mind, and not being peifeetly mastei of the ciicumstanees, he ivithheld 
his sentiments, in ivliich state of lestiaint he ivent into the next loom, and 
tuining lound to Di Robeitson, one of the physicians of the hospital, he 
gave a deep gioan, and diopt down dead 

At the time of his death lie was in tlie 65tli 3'eai of his age, the same 
age at which his bi othei, the late Di Iliintei, died Upon inspecting 
the body aftei death, the following iveie the appeal ances the skin in 
seveial places was mottled, paiticulailj’’ on the sides and neck, which 
aiose fioni the blood not haiing been completely coagulated, but le- 
maining neail}^ fluid 

The peiicaidium was leiy unusuallj’- thickened, ivhich did not allow 
it to collapse upon being opened , the quantitj’- of watei contained in it 
was seaicely moie than is fiequentlj’ met with, although it might prob- 
ably exceed that which occuis in the most healthy state of these paits 

The heart itself ivas veij" small, appealing too little for the cavity in 
which it lay, and did not give the idea of its being the effect of an un- 
usual degree -of conti action, but moie of its having shiunk in its size 
Upon the undei surface of the left auiicle and ventiiele, tlieie were two 
spaces neaily an inch and an half squaie, which weie of a ivliite coloui, 
with an opaque appeal ance, and entiielj’- distinct fiom the geneial sui- 
face of the heait these two spaces weie covered bj’’ an exudation of 
coagulating lymph, which at some foimei peiiod had been the lesult of 
nflammation there The miisculai stiuctiiie of the heart was paler and 
loosei in its textuie than the othei muscles in the body Theie weie no 
eoagula in any of its cavities The coionaiy aiteiies had then blanches 
which ramify thiough the substance of the heait in the state of bony 
tubes, which were with difficulty divided by the knife, and their tians- 
verse sections did not collapse, but lemained open The valvulae 
mitrales, where they come off fioni the lowei edge of the auricle, weie 
in many places ossified, foiming an impeifectly bony niaigin of different 
thicknesses, and in one spot so thick as to foim a knob , but these ossifica- 
tions were not continued down upon the valve towaids the choidae 
tendineae 


[ 274 ] 



The semilunai valves of the aoita had lost their natuial pliancy, the 
previous stage to becoming bone, and in seveial spots theie iveie evident 
ossifications 

The aoita immediately beyond the semiluiiai valves had its cavity 
laiger than usual, putting on the appeal anee of an incipient aneuiism, 
this unusual dilatation extended foi some ivay along the ascending 
aoita, but did not leaeli so fai as the common tiimk of the axillaiy and 
carotid arteiy The inciease of capacity of the aiteiy might be about 
one-third of its natuial aiea, and the inteinal membiane of this pait had 
lost entiiely the natuial polish, and was studded ovei with opaque white 
spots raised higher than the geneial suitace 

From this account of the appearances observed aftei death, it is 
reasonable to attiibute the piineipal symptoms of the disease to an oi- 
ganie affection of the heart That organ was lendeied unable to cany 
on its fuiietions, whenevei the actions weie distuibed, eithei in conse- 
quence of bodily exeition, oi affections of the mind 
The stoppage of the pulse aiose fiom a spasm upon the heait, and in 
this state the iieives weie probably piessed against the ossified aiteiies, 
which may account foi the exeiutiating pain he felt at those times 
The othei symptoms may lie explained from the defect in the valves 
and the dilatation of the aoita, which had lost its elasticity 
In the last attack the spasm upon the heait was eithei too violent in 
the degiee of contraction, oi too long continued to admit of lelaxation, 
so that death immediatelj'’ ensued 

His lemains weie inteiied in a vault iindei the paiish chinch of St 
Jlaitni in the Fields, attended by a few of his oldest medical fiiends 


[275J 




1806 

the or OP r. 




JEAN NICOLAS CORVISART 
Portrait by Charles Bazin, etched by Delpech 


{Courtesy Charles C Thomas ) 



JEAN NICOLAS CORVISART 

(1755 1821) 

/^N THE tiny French village of Dricoiirt, not far from Vouziers, Jean Nicolas 
cJ Corvisart was horn on February 15, 1755 As was to happen later to Laennec, 
Corvisart early in life was sent to live with his uncle, who was the pastor of the 
parish at Vimille 

At the age of thirteen, Corvisart matriculated at the College of Saint Barhe 
There he showed no signs of intellectual superiority, hut, according to Beeson, was 
“lazy, mischievous, and quarrelsome ’’ Oiiginally it was intended that Corvisart 
was to become a lawyer, hut while studying for the bar, he visited many hospital 
clinics in Pans These visits made a profound impression on him, so he decided to 
forsake law for medicine 

This decision angered his father to such an extent that Corvisart was expelled 
from the paternal home He immediately applied at the Hotel-Dieu in Pans for a 
position which would insure his hoard and room This he secured and with it came 
the splendid opportunity of studying medicine in one of the world’s most famous in- 
stitutions 

In 1785, the Pans Faculty of Medicine conferred upon him the degree of doctor- 
regent Corvisart later became an associate to the chair of anatomy in the Hotel- 
Dieu He also assisted in the courses m operative surgery, obstetrics, and physiology 

On the death of Desbois de Rochefort in 1788, Corvisart succeeded him as phy- 
sician to the Charite Hospital, and with the establishment of the medical school in 
1795, Corvisart was chosen to occupy the chair of medicine In 1797 he became 
professor of medicine at the College de France, and in 1799, Corvisart and Barthez 
became physicians to the government 

In 1804:, Corvisart had the honor to become personal physician to Napol6on 
Bonaparte He had known Napoleon at an earlier date, for in 1798 Bonaparte had 
presented him with a large carved mahogany chair which Corvisart had placed in 
his consulting rooms This chair, now a highly valued antique, is still a cherished 
possession of the Corvisart family 

From all accounts, Napoleon and Corvisart greatly enjoyed each other’s company, 
and many interesting anecdotes are told of their conversations In one of these, it 
IS said that the Emperor, who was in constant fear of bemg poisoned, literally rolled 
on the floor because of a slight attack of indigestion Corvisart is supposed to have 
reproved him, saying, “Get up' What would be said if the master of the world were 
seen thus crushed by fear‘>’’ 

Perhaps the most famous story is the reported conversation related by Beeson, 
between Corvisart and the Emperor following the birth of Napoleon’s son, the King 
of Rome, in 1811 

“Sire,” said the physician, “this child should fulfill your last wish Consider 
from what a position you have arisen m less than ten years lieutenant, captain, 
brigadier-general, general-m-chief. First Consul, Emperor, spouse of an Austrian 
Archduchess, and the father of a male child You have reached the summit of the 
Wheel of Fortune and of great renown Stop' Sire, or Destmy may desert you and 
then nothing remains but downfall and disaster ’ ’ 


[ 279 ] 



“Well,” replied the Emperor, “that was such a speech as one would expect from 
a native of the Champagne ’ ’ 

In reading the works of the famous Viennese physician, Max Stoll, Corvisart 
learned of Auenhrugger’s treatise on percussion He became very much mterested 
in this new diagnostic procedure, and after practicing it for several years, trans 
lated Auenbrugger’s treatise in 1808, adding several ongmal observations As we 
have mentioned in our biographic account of Auenbnigger, much credit is due to 
Corvisart for bringing into professional favor the discovery and use of percussion 
as an important aid in physical diagnosis 

Corvisart realized the importance of presenting to French medicine in translation 
the works of some of the important foreign physicians In 1797 he translated Max 
Stoll’s masterful work “Aphorisms on the Knowledge and Cure of the Fevers ” He 
also translated the aphorisms of the great Boerhaave in 1802 In this connection it is 
interestmg to note that many years later a favorite pupil, Laennec, published the 
aphorisms of his learned teacher, Corvisart 

The many contributions of Corvisart to cardiology are contained m his work en- 
titled “Essai sur les maladies du coeur et des gros vaisseaux,” which was first pub 
lished in 1806 Among the outstanding contnbutions to this field were his observa- 
tions on the distinctions between cardiac and pulmonary disorders and the differ- 
ences between functional and organic cardiac disease Beeson wrote that Lassus 
was “of the opinion that Corvisart’s most important contributions to cardiology 
were (1) the distinction between cardiac hypertrophy and dilatation, (2) the 
division of the clinical course of heart failure into three periods, and (3) the con- 
nection between cause and effect in valvular lesions and heart failure ’ ’ We have 
chosen to reproduce from Gate's translation of the “Essai,” published in 1812, some 
of Corvisart’s original observations 

During the peak of his career, Corvisart was physician to many distinguished 
women of the time, including the Empress Josephine, the Empress Marie Louise, 
Hortense de Beauharnais, who was Queen of Holland, the Queen of Spam, the beauti- 
ful Fauline Bonaparte, who like her mighty brother died of cancer, and Madame 
Walewska, whom he is said to have dearly loved 

In the short interlude of Napoldon’s return to power before his defeat at Water- 
loo, Corvisart again served as physician to his old friend Soon after the Emperor’s 
final defeat, Corvisart retired, it is said, to Courbevoie near Pans In 1815 he suf- 
fered a mild cerebrovascular seizure, followmg which he retired from the practice 
of medicine On September 15, 1821, he suffered a final attack, which resulted in 
his death a few days later, approximately four months after the demise of the former 
Emneror at St Helena on Mav 5 


[ 280 ] 



ESSAY 


OV THE 

ORGANIC DISEASES AND LESIONS 

OF THE 


HEART AND GREAT VESSELS. 


mOM THF CIIMCVT LFCTinFS 0^ 


.T N. CORVISART, 

First PIi>siLian of tlicii Tml»LmI anil Roj il Ma|cstics, ORlccr nf the T r^inn at 
Hoiioi, TIoiioiaij I’rotcssiir ot the School nl Mchtint nt Puis, 
and ot the IiiiiicimI C olliqc ol h ranee I’htsitian in Chief 
ol llie llobinttl ot LnChaiite, Ac Ae 


rUBIISHtD, LNDEB HIS INSPECTION, BY 

C E. HOREAU, 

Woetcii m Mcdiemc, SHi,;pon of the Infiiinaiy and IloU'e ol thi 
Einpcior iiid Ivins^ 


Hzret latcri Irthaln. iminln 

>IBI( iFSElD 


TRtNSl Mi-DHtOai TJtl i-urNt P, 

wn H NOTES, 

BY JACOB GATES, M. M S. h. 


ROS I ON 

PUBLISHED BY BllADFORD ^ READ, AND BY 


ANTHONY IINI.EY, PHILADELPJnV 

1812. 



ESSAY ON THE DISEASES AND ORGANIC 
LESIONS OF THE HEART-f 


THIRD CLASS, CHAPTER III, ARTICLE III 
OF THE SIQNS PECULIAR TO THE CONSTRICTIONS 
OF THE ORIFICE! 


T he caitilagmous oi osseous mduiation of tlie oiifiees of the auiicles 
and ventiieles, of the mitial and tiicuspid valves, of the aortic and 
pulmonaiy semi-lunai valves, and the vegetations, growing upon eithei 
the ventricular oi aiteiial valves, tend piincipally to pioduce a more or 
less complete constriction of the oiifices affected 
When these constrictions exist, the ciiciilation is embariassed, and its 
phenomena singularlj’- peiveited By obseiving the disoidei of the cir- 
culation, the piactitionei may find, in the living man, I should piesume, 
certain signs of this species of affection 
To point out with accuiacy these signs, it is necessaiy to make a dis- 
tinction between the different affections of which I have been speaking 
1st, those which pioduce a peimanent obliteiation of the orifices, 2d, 
those which form this constiietion but momentaiily 
In the fiist lank, must be placed the induiations, and ossifications of 
the circles and ventiicuJai valves, as the effects of this peimanent morbid 
state are the same in eveiy instance, and aie evei perceptible to theprac- 
titionei In the second, must be placed the vegetations, or excrescences 
which are noticed upon the ventiicular and sigmoid valves, whose pres- 
ence IS kno-wn only at intei vals, when these bodies, generally floating in the 
cavity of the ventricle, oi vessel, appear at the orifice, and edge where their 
base IS fixed 

The signs of constiiction aie commonly the more obscure, as the constric- 
tion is the more remote fiom the beginning of the general arterial system, 
because it is by consideiing attentively the derangements which obtain 
in the action of this system, that the Imowledge of the signs is acquired 
I will explain myself the constrictions which are formed by the ossifica- 
tions surrounding the oiifices oi valves of the light heait, as well as of the 
pulmonaiy artery, appear veiy difficult to comprehend on the living sub- 


»Corvjsart, Jean Nicolas Essai sur les maladies et les lesions organiques du coeur, 
Pans 1806 English translation by Jacob Gates M M S S 1812 pp 182-189 and 299-303 
tM Corvisart planned his book on the basis of the medico-anatomic aspects of the 
heart He used the word class instead of the usual part ’ or section l*micate 
various portions of his work beginning with 'First Class and ending with 'Fifth Class 
and “Corollaries ” The portions reprinted herein are from the Third Class and the 
"Corollaries/ respectively — F A W, 1940 


[282 ] 



3ect Wheie can we, m slioit, discover the signs proper to make them 
understood^ The regular oi perveited action of the light cavities of the 
heart are haiely made sensible m the organs suboidinate to the influence 
of the less cii dilation , likewise the disoidei of the action of the leftkeait 
can be comprehended only in the natuie of the arterial pulsation, or what 
amounts to the same, in the phenomena of the greater cii dilation 

Could we examine the pulsations of the pulmonaiy aiteiy or its branches, 
as we do the pulsations of the aoita oi its branches, we should recognize 
with equal ease, both the constiictions of the oiifices of the light heait, and 
the same lesions when they obtain in the oi ifices of the left cavities , but 
such an investigation is impossible, and we aie obliged, in this case, to 
examine the state of the lungs Now, is it known, oi shall we be ever able 
to know what disoidei, oi lathei what modification respiration will 
undeigo, when the lungs, from a eonstiiction either of the ventricular 
orifice of the iiglit side, oi of the mouth of the pulmonaiy artery, will 
leeeive a less quantity of lilood than what ought naturally to be con- 
veyed to them, and upon which lespiiation exercises its vivifying in- 
fluence^ It IS supposed that a particulai modification of respiration 
must furnish the signs which I am endeavoiing to discover, but such a 
modification is not sufficiently piominent, and sti iking, oi rather we 
aie not endowed with sufficient undei standing, to recognize such a 
peculiar modification of respnation among the multitude of signs which 
this function evinces in the diffieient affections of the lungs 
If we cannot compiehend tlie signs of the constiictions of the right 
orifices of the heait, can we expect to be moie successful in a particulai 
change of the phenomena of the greater cnculation'? The influence of 
one of the two ciiculations over the other is such, that, the one being dis- 
ordered, it IS impossible foi the othei not to paitake of the disorder But 
what can be the peculiai nature of the disordei which must exist I 
doubt whether observation gives the practitioner a diagnosis subtile 
enough to discriminate the alteration of these orifices in the particular 
disordei of respiration, unless he be assisted by all the concomitant signs 
By reasoning physiologically, it may be advanced that the small 
quantity of blood conveyed fiom the right cavities of the heart, into the 
lungs, thence into the cavities of the left heart, and filling these cavities 
partially, will stimulate them imperfectly, that from this insufficient 
stimulus will arise feeble and slow contractions, which will induce debility, 
softness, and slmvness of the pulse, etc But in this case, as in various 
others, to how many gioss mistakes, would not he be incessantly exposed 
who should so restrict the morbid phenomena to the opinions of physiology, 
and who should always find in these too often hypothetical opinions, the 
knowledge of the phenomena which aie to characterize any such affection! 
How often does not clinical obseivation overturn such theoretical specula- 

[ 283 3 



tions, as It will subveit soonei oi latei many otheis, ivhose ioundatioiis 
appeal as unstable as those loo fiequently established by the spiiit of in- 
noyation ' 

Theiefoie the collection of a gieat numbei of symiitoms would be neces- 
sary to elucidate the diagnosis of the const notions of the light oiifiees, the 
countenance must appeal of a liyid hue, a moie maiked engorgement of 
the geneial yenous system, and paiticiilaily of llie liyei, the size of this 
oigan increased, the dyspnoea gieatci and longei continued, all the signs, 
in fact, which can point out the affection of the light cayities, which aie 
usually dilated in consequence of constiietions of the light oiiflces, aie 
joined to the chaiactei of the pulse, which, in this case, is less iiiegulai 
than in the consti ictions of the left oiifiees, but less legiilai howeyer than 
natuial 

The obseuiity, inyolying the signs of the consti ictions of the light oiifiees, 
IS not entiiely dissipated, when it is requisite to recognize the impeifect 
obliteration of the left auricle and yentiicle Beside the general signs of 
the diseases of the heart, which arc cyei found in this case as in the first, 
because an aneuiismal complication geneially obtains, some paiticiilai signs 
manifest the affections in question 

Of the preceding numbei of symptoms is a peculiar rushing like water, 
difficult to be described, sensible to the hand applied oyer the piecoidial 
region, a rushing which pioceeds, appai entlj’', fiom the embaiiassmeiit 
which the blood undergoes nr passing thiough an opening which is no 
longei proportioned to the quantity of fluid which it ought to discliaige 
The same rushing is also lecogni/ed, though it is much less maiked, by 
the hand that inyestigates the phenomena of the pulse This chaiactei 
is not likewise the only one by which the pulse announces the existence 
of the conti action of the left oiifice, it is effectually less regular than 
in the ease of consti ictioir of the light orifices, but less iriegulai than 
when the aortic orifice is deianged Besides it presents nerther impetus, 
hardness, nor fulness, because the quantity of blood which the left ven- 
tricle propels, IS proportioned to what it leceives fiom the auricle which 
IS imperfectly emptied, moreover, the action of this ventricle cannot be 
vigorous, since it is feebly stimulated 

Notwithstanding the deficient excitement of the left ventiicle, it must 
not be believed that in this case, the strokes and palpitations of the heait 
are continually weak and obscure The right cavities, and the left 
auricle in particular, acquire very often a thickness and foice which 
render the conti actions extremely distinct, they may even become moie 
violent in this ease than in any other, as the stiokes of the heait depend 
on the motion of the auricles which propels this organ, and the force of 
this motion of the auricles augments in proportion to the difficulty they 
encountei in driving the blood thiough then constricted orifice 

[284 1 



When the iiidiuated and ossified senii-liinai valves of the aoita stop 
a poition of this vessel, the obstacle Avliich they foim bieaks the wave of 
blood piopelled by the heait into the aiteiy, stiong and fiequent 
palpitations supeivene, liecaiise the heait is easih" filled, but is difficultly 
emptied, thence lesults a inoie pi oti acted lesidence of the blood m the 
left cavities, a longei application of the stimulus of the blood on the 
paiietes of the heait, in fact, a greater iriitation of the organ The 
pulse,' in this ease, may pieseive a ceitain degiee of haidness, and 
iigidity, but never much fulness or legulaiity This continual ir- 
regulaiity, often inei eased by the frequency and foice of the palpitations 
will always be sufficient to establish the piecise diagnosis of the constric- 
tion of the aoitic mouth, oi the lesion of its valves Here is no obscuiity, 
the physician with piactice and attention ought evei to pionounce with 
confidence, and his diagnosis can no longei be uncertain though he should 
have foi a guide onlj’’ this species of undulation, this lushiiig noise, dull 
tiembling, the characteis so manifest bj^ the pulse in eveiy case of this 
natuie 

Case XL A coachman, foity-eight yeais of age, lobiist, and of a 
sanguine temperament, had, thiee days before his admission into the 
hospital, suffeied a veiy sei^eie peiipneumony, tieated mostly by yenesee- 
tion He was haidly convalescent, when he came to the hospital. May 28, 
1800 I lequested him to go into the Clinical Hall foi the puipose of 
examining his pulse, which indicated an oiganie lesion of the heart 

The pulse ivas veiy full, and even rigid, on the right side, small, soft, 
obscure and scarcely sensible on the left, but irregular, undxdahng and 

emulom on each side 

He Avas attacked Avith haemoptysis and A^ery considerable suffocation , the 
suffocation appealed instant, the eyes Avete wild, the face injected, the 
thorax here and there painful did not sound toAvard the region of the 
heart and the loAA^ei part of the right side The pulse pieserA^ed the same 
character 

From the effects of percussion, difficulty of breathing, haemoptysis, 
and characters of the pulse, I recognized the existence of hydrothorax 
Avhich I judged to be subsequent to an organic lesion of the heart Avith 
constriction of the aortic orifice 

The patient, Avhile he remained here, Avas bled seA^eial times, and ob- 
viously relieved, but greatly debilitated, an obstinate eostiveness required 
the use of mild purgatives 

Sometime after the iiifilti ation, Avhieh already existed, nrei eased, 
diuretics, aperients, and aiiti-spasmodies, piocuied but veiy little relief 
The patient had no rest, and Avas obliged to sit up night and day, when 
the hand Avas applied over the region of the heait, he Avas endangered 
AAith suffocation He became a A’lctim to this senes of symptoms, 5th 

[ 285 1 



June, eight days aftei his admission into the hospital, and fom aftei the 
penpneumony with Avhich he was affected 

On opening the body, theie was much watei in the light cavity of the 
thoiax, but little in the left The lungs weie haid and adheiing to the 
pleuia The peiicaidium contained no seium, the size of the heait was 
much enlaiged, the light aiiiicle and imiitiicle piesented nothing lemark- 
able The left auiiele was sound, with a laige oiifice, upon the valves of 
which was obseived an incipient ossification The left ventiiele was 
hard, thick, and veiy fleshy, the tendons of the valves weie neaily ossi- 
fied The aoitic valves weie ossified and united so closely that the end 
of the little fingei could scaieely be intiodueed into the oiifiee of the 
aoita, this aiteiy was dilated, lugoiis and thickened to the end of its curva- 
tuie The left subclavian aiteiy was about an inch fiom its oiigin so con- 
stiicted as seaicely to admit tlie liead of a laige pm The constiiction was 
owing to the osseous thickening of the aiteiial paiietes 

The neailj’' complete obliteiation of the left siibclayian aiteiy explains 
peifeetly why the pulse was seaieely sensible on this side, but this smgiilai 
chaiaetei could not obsciiie the diagnosis sufficientlj" demonstiated by the 
othei s'sniiptoms, and paiticiilaily b)' the continual iiiegulaiity of the 
pulse 

To conclude what I haye to say on the signs of the const! ictions, it le- 
mains foi me to speak of the cases wheie the obliteiation of the oiifice is 
monientaiily piodueed by the piesence of an excieseence, yegetation, or 
polj^pous concietion on this pait 

When these yegetations aie found appended to the mitial yalyes, they 
are announeed by all the signs peeuliai to the constiiction of the left 
aiiiiciilai oiifice, with this exception, that most of these signs aie lepio- 
duced, in this last case, only at inteiyals moie oi less i emote Though, 
during the conti actions of the left yentiiele, these appendages, constantly 
floating at the aoitic mouth, continue applied against the walls of the 
yessel, then effects aie then yeiy neaily the same as those piodueed 
by the simple ossification of the semi-liinai yalyes of the aoita, and the 
constiiction which this ossification occasions in the apeiatiiie of the 
vessel, but do these exci escences, by then weight, or any othei cause, 
compiess the valyes, and appeal at the aortic orifice, duiing the contrac- 
tion even of the ventiicle, it is obvious that a momentaiy and neaily 
total obliteration of the apeituie of the aoita will follow Tins closuie 
inteicepts inpeifeetly, foi some instants, the passage of the blood, thence 
the successive legiilaiities and niegulaiities of the pulse, the fiequent 
and paitial syncopes, this momentaiy niteiiiiptioii of the cn dilation 
compels the heait to ledoiible its effoits to sin mount the obstacle that 
opposes it, thence the repeated stiokes and violent palpitations of this 
oigan which cease as soon as the obstacle is lemoved, and which are re- 
newed when It IS lepiodueed, thence the impossibility, sometimes very 

[ 286 ] 



protracted, of feeling the pulse, while within an instant, these pulsations 
leturn with monieiitaiy force, vivacity, frequency and regularity 
I have nothing to say of the signs of the pulmonary sigmoid and 
tiieuspid valves, as I have but seldom had the oppoitunity of observing 
them, besides, I think, as it has been alieady remaiked, that, though this 
morbid state should be moie fiequent, it would be as difficult to indicate 
the paiticulai signs of the kind of affection, as it is to distinguish the con- 
strictions of these same oiifices fioin those of the left cavities 


COROLLARIES 
ARTICLE IV 

OF THE PROQNOSIS OF THE DISEASES OF THE HEART 

When the diseases of the heart assume an acute oi chronic charactei, 
the prognostic is always veiy peiplexmg Nevertheless there are im- 
poitant modifications to make to the general proposition which I have 
just annouiieed 

In ordei to establish, with exactness, the piognosis of the diseases of 
the heart, it is necessary to distinguish these diseases into several kinds 
they may be divided, (1) into acute, (2) into chiomc organic, and (3) 
into organic piopeily called 

1 The acute diseases of the lieait cannot with propriety be inserted 
among organic diseases, those which come under this denomination, are 
acute penca/idxhs, and caidths, oi inflaimnation of the substance of the 
heart 

In respect to the prognosis, these diseases follow the same order as do 
all acute inflammations in general, the gi eater danger that they bring with 
them, in many cases, is the only point in which the prognosis differs It 
geneially vanes as do the same degrees of these inflammations 
When acute peitcmdiUs is not announced in the beginning by strong 
sjonptoms, or severe accidents, and a marked disturbance m the action 
of the heait does not signify that the organ itself is sensibly affected, and 
the contiguous visceia, as the lungs, etc seem not to participate of the 
inflammation, when the subject is besides, sound and well organized, then 
a pietty favorable prognosis may be formed, hence it is not extiaoidinary 
to see pencaiditis, which is otherwise one of the severest affections, attain, 
by the combined efforts of nature and ait, to a happy termination 
But the cases in which the solution of the disease is satisfactory, are not 
the most common, it seldom happens, theiefoie, that this inflammation 
IS found distinct from those of the pleurae costales, diapliiagmatieae, 
mediastinae, pulmonales, and liom the same affection of a greater oi less 
portion of the substance ei’^en of the lungs, and of the surface of the heart 
Itself, which 111 every instance, is more or less inflamed, then, the disease 

[ 287 ] 



eithei teimmates m death, oi is tianstoimccl into one ot those alteiations 
Avhieh I have designated undei the name oi chjomc o)qamc, aecoidingto 
the piiiulence of the peiioaidium, the adhesion oi this membiane to the 
lieait, its chionic inflammations, etc, etc 

The piognosis of the inflammation oi the testiue of the heait, or of 
ccnditis united with the same affection oi the othei Mseeia of the thoiax, 
01 destitute oi eomplieations, is ahvavs most peiplexing, not to say moital, 
111 all eases Seldom, theiefoie, does the inflammation of the paits, whose 
miiseulai substance constitutes the basis, obtain without its teiminatmg in 
suppuiation, and the suppuiation oi the oigans contained in the great 
cavities of the body is gencialh moital 
It IS my belief that acute cmdihs has never been seen to leach a perfect 
solution, and wlieii cases aie quoted, all doubts aie not icmoved, some 
veiy lustly lemain as to the actual scat oi the inflammation, which cannot 
nival lably be Avell ascci tamed 

Hence this mflammation almost ah\a-\s teiininates fatally, but the 
death which it usually occasions may happen instanth oi somewhat slowlj 
Thus caidttis has been known to become fatal m a Aciy lew days, while 
in other instances, uhen the disease lias attained to its highest degree, 
the most alaiming sAmptoms pailialh disappeai, and a soit of eoiiA’ales- 
ceiiee is established, sometimes even the patient is lestoied to apparent 
health, he then flatteis liimseli Aintli a neai and peifect cine, but the moie 
intelligent physician peieeiA’'es only a tiansioi matron, oi degeneiation of 
the disease into another affection sIoaaci, but not less scA^ere, as n chomc 
organic disease is then established, moital in all cases 
Anroiig the acute lesions of the heart, considered relatively to the prog- 
nosis, ought to be inserted the partial ruptures nientioiied in this Avoik, 
and the rupture ot a fleshy pillar of the heart, and of the AalA'ulai tendons 
The rrrptuie of the fleshy pillars of the heart (Case XLIV), seems to 
assume all the most sensible characters of an acute disease, this is at 
least the infeience that must be diaAvii fiom the consideiation of the 
assemblage of accidents to Avhiclr the eouiiei became the victim 
The prognosis in the cases wheie this lesion is manifest, aviII theiefoie 
be desperate, and the physician must announce the fatal event of the 
disease, AA'^hich occasions death sooner, as the lesion happens suddenly in 
a sound organ 

The rupture of the valvular teirdons appears, according to my obseiva- 
tions, to be not so severe and so immediately fatal as that of a portion 
of the muscular substance Hence nr almost all cases in Avhich this rup- 
ture has been observed, an organic disease of the Avhole of the heart 
has rnAmiiably folloAved, Avithout airy acute affection of this organ 

The prognosis of the entiie rupture or laceration of one of the cavities 
of the heart is here omitted, such accidents are hardly ever knoAvn but 
from then effect, Avhieli is sudden death, oi at least exceedingly quick 

[ 288 1 



2 The dibeabCb oi the heait to which 1 gn e the name of du omo o) game, 
aie almost all fiom the ettects, consequences oi degeiieiations of acute in- 
flammations whose piognosis has just been mentioned, of this numbei aie 
the seious oi puiulent eftusions into the peiieardium, the adhesions of 
this membiaiie to the heait, the ulcerations of the surface of this oigan, 
its chronic inflammation, the softening of its textuie, etc 

These various affections aie almost all, let it be lepeated, the lesults 
of acute inflammations of the heait Thus, when pencaidihs has leached 
so fai that the symptoms usually become moie model ate, the disease seems 
sometimes to lose its intensity, but it is eyidentlj piotraeted faither than 
theie was leasoii to expect, then the affection aequiies diffeient chaiacters 
which, on account of then being less seveie, aie not less embaiiassmg to the 
eye of the expeiieneed physician The piognosis, at fiist unceitam, though 
aluays dangeious even in the beginning of the disease, less detrimental 
when the inflammation earned to its Inghest degiee, is suddenly model ated, 
it becomes iiioie and moie unfavoiable when the eoncuiience of paiticulai 
signs announces that the disease is mistaken, that it degeneiates, that a 
seious 01 puiulent effusion is foimed ni the peiicardium, oi the disease 
assumes some othei tioublesome teimination 

If the physician has not been able to decide as to the dangei of the 
affection which has pieceded that whose piognosis he wishes to establish, 
the inquiiies which he will be obliged to make foi the purpose of gaining 
a knowledge of the disease, will teach him also what piognosis he ought to 
f 01 ill 

3 If, 111 01 del to tieat of the piognosis of the diseases of the heait, I had 
divided them into cuiable and nicuiable, among the fiist, might have been 
nisei ted with the acute inflammations, most of the diseases piopeily called 
beginning o) game, which would undoubtedly yield to caie, and medical aid, 
weie the fiist symptoms of these diseases, to the patients themselves, suf- 
ficiently evident and strong to induce them to apply foi assistance on the 
fiist appeal aiice of the disease, foi as it has alieady been said, theie are 
physical and moial signs, by the benefit oi which the experienced and 
attentive physician may well suspect then foimation 

But, if these oiganic lesions aie old, if they have made evident piogiess, 
if all the functions which aie connected with the cii dilation, suffei alieadj’ 
fioni its alteration, then the piognosis is altogether despeiate, the physi- 
cian has no longei to estimate the dangei ot the disease , ivlienevei he ascer- 
tains its existence, he leeognizes a mortal affection, and his expeiience can 
enlighten him only in estimating the time that the patient will be able to 
lead a lingeimg life, and in the choice of the means capable of lendeimg 
It the most siippoi table 

It IS fiom the chaiactei, intensity of the oigamc lesion, the constitution 
of the individual, his mannei of living, etc, etc, that the physician can 

[280 1 



pronounce concerning the fatal, near, oi moie or less i emote, period of the 
subject exposed to Ins observation 

If the attack of the organic disease has been sudden, if, fiom the begin- 
ning, it has assumed some dangeious symptoms, if a veiy great disturb- 
ance of the eii dilation announces a deep lesion of the principal organ of 
this function, the prognosis will be far more troublesome than had the 
disease been more moderate in its attack, and presented different or 
opposite symptoms 

Relatively to the constitution of the individual, if it is vigorous, if the 
subject IS in the flower of his age, if he is free from the various degenera- 
tions of the humors, without violent passions, obedient to good advice, 
etc it will be found that the termination is not so soon fatal as m the 
contrary conditions Finallj^, as to the manner of living, if the patient is 
devoted to vice, debauchery, and every kind of excess, if, fiom his condi- 
tion, he is exposed to hard labor, to the inclemency of the atmosphere, 
to laborious exeicise, and to lively moral affections, etc, it will hasten so 
much the end of his life, wliile bv Ihe means of sobriety, temperance, and 
caie, he will not only prolong his daAS, but will be able even to prevent, for 
years, the organic disease, to which sooner or later he will fall a victim 


[ 290 ] 



1812 

WILLIAM CHARLES WELLS 

ONE OF THE EARLIEST CLINICAL REPOP.TS ON THE 
CARDIAC PARTICIPATION IN RHEUMATIC FEVER 



WILLIAM CHARLES WELLS 

(1757-1817) 

CHABIjES wells was born in Charleston, South Carolina, on 
KM/ May 24, 1757 His parents had emigrated from Scotland in 1753 His father 
was a bookseller who was also skilled in the art of bookbinding As was the custom 
among Colonial booksellers, he owned a printing press and later undertook to pub 
lish a newspaper The Wells family was firm in Its loyalty to Great Bntain In 
keeping with the ideals of the Southern gentry, young William was sent across the 
sea to gam his preliminary education He attended grammar school in Dumfnes, 
Scotland, for two and a half years At the end of that time he spent one year as 
an undergraduate in the University of Edinburgh 

In 1771, Wells returned to his native city and became apprenticed to Dr Alex- 
ander Garden Dr Garden was not only Charleston’s most prominent physician but 
also had a deep interest In zoology and botany He was a member of the Eoyal 
Societies of Upsala and London, and corresponded in Latin with Lmnaeus, who 
perpetuated Garden’s name by the gardenia, which he called “one of the most 
beautiful flowering shrubs in the world ’ ’ 

With the outbreak of the War of Independence, Wells, whose sympathies were 
with the King, left for England to be with his father, who had returned to England 
a few months previously In 1776 young Wells began the study of medicine at the 
University of Edinburgh In 1778 he passed his prelimmary medical examinations 
He then went to London and there attended the lectures on anatomy and midwifefy 
given under the able direction of Dr William Hunter Later he spent some tune at 
St Bartholomew’s Hospital and then studied in Leyden for three months Wells 
returned to Edinburgh and in June, 1780, received his medical degree 

To settle his father’s business, which apparently had been mismanaged by an 
elder brother, Wells embarked on a trip to the Carolmas When the Tories lost con 
trol of Charleston, Wells moved the printing press and stock to St Augustine, 
Florida There he had no tune for the practice of medicine, but became printer, 
bookseller, merchant, and trustee He also spent some time acting in a local theater 
company On his return to Charleston, Wells was obliged to spend three months in 
prison because of some debts his brother had accumulated After more difficulties 
which arose because of his loyalistic tendencies, he sailed for England in May, 1784 
On his return to London, Wells became acquainted with Matthew BaiIIie,i with 
whom he later became intimate He also numbered among his close friends David 
Hume, Lord Glenlee, Robertson Barclay and William Lister In 1785 he began the 
practice of medicine in London 

In 1788, Wells became a licentiate of the Royal College of Physicians, and in 
1789 became physician to the Finsbury Dispensary, an appomtment which he held 
for ten years In 1795 he was elected assistant physician to St Thomas’ Hospital, 
and in 1800 he was promoted to the rank of physician 

>See pp 255-256 biographic sketch of Matthew Baillie 

[292] 



In 1792 he published the important work that has endeared him to ophthalmolo- 
gists, his “Essay on Vision “2 Therein he explained why objects are seen singly 
with the two eyes Because of this contribution, presumably, he was elected to the 
Eoyal Society in 1793 

Another important work of Wells appeared in 1814 This was his “Essay on 
Dew “3 Pleadwell suggested that it was the foundation stone of the modem science 
of ventilation In 1814, also, Wells was elected a fellow of the Eoyal Society of 
Edinburgh. 

That Wells anticipated Darwin in recognizing the principles of natural selection 
IS suggested in his paper entitled “Account of a Female of the White Race of Man- 
kind part of whose Skin resembles that of a Negro “ This was published in 1818 
in his collected works 

Wells' classic article on rheumatism of the heart, which it is our privilege to 
reproduce, was written, it must be remembered, before the time of the stethoscope 
For this reason alone, his contribution to the study of this disease is remarkable 

It seems that David Pitcairn, the prominent English physician, who with Matthew 
Baillie had proposed Wells for fellowship m the Royal College of Physicians in 1797, 
with an unsuccessful result, was the first physician to express a knowledge of the 
relationship of rheumatism to heart disease Matthew Bailhe referred to Pitcairn’s 
discovery of 1788, m the second edition of his work on “Morbid Anatomy,” pub- 
lished in 1797 Wells also referred to Pitcairn in his article Unfortunately, Pit- 
cairn did not publish his observations on rheumatism and heart disease 

On July 29, 1789, Edward Jenner is said to have read a paper before the Fleece 
Medical Society^ on “Remarks on a Disease of the Heart Following Acute Rheuma- 
tism ” It IS to be regretted that the manuscript of this paper was lost and that 
Jenner’s observations were never published Wells did not know of Jenner’s work 
on this subject Sir David Dundass noted the disease in 1808 and in the same yeai, 
according to Keil, J F Davis made note of a colleague’s observations on “Acute 
Rheumatism Attacking the Heart ” Wells’ contribution, the first thorough treatise 
on this disease, was read in 1810 and published in 1812 

In 1800, at the age of forty-three. Wells began to suffer from apoplexy The 
disease incapacitated him for several months However, he placed himself on a 
limited diet and managed to remain in fairly good health until 1813 His health 
then became poor from general weakness, associated with shortness of breath and 
swellmg of the ankles Wells noticed in 1817 that he frequently made the sudden 
and deep inspirations which are suggestive of the disease John Cheyne was to de- 
scnbe a year later 

In August, 1817, his physicians. Lister and Baillie, who were also personal 
friends, abandoned hope for his recovery as did Wells, himself He died in London 
on September 18 of that year 


“Wells William Chailes An essay upon single vision with two eyes, together with 
expenments and oVseivations on seveial othei subjects in optics, London, T Cadell, 1792, 

111 pp 

“Wells, William Charles An essay on dew, and seveial appeal ances connected with it, 
London Taj lor and Hessej 1814 140 pp 

’30tt on Edaaid Jennei s lost nianuscnpt on ‘ Kheumatism of the 
Heart” Bull Hist Med 7 409-411, 1929 

1 "3^^6*^1808^^'’'^ account of a peculiar disease of the heait, Med & Chii Soc 

[ 293 ] 



ON RHEUMATISM OF THE HEART" 

By 

WILLIAM CHARLES WELLS 

D r DAVID PITCAIRN, about the jeai 1788, began to lemaik, that 
poisons subject to ihonmalism iveie attacked moie fiequently than 
otheis, with sjanptoms of an oiganic disease ot the heait Subsequent ex- 
perience having eonfiimed the tiuth of this obseivation, he concluded, that 
these two diseases often depend upon a common cause, and in such in- 
stances, theiefoie, called tlio lattei disease iheumatism of the heait He 
communicated what lie had obseiied to seieial of Ins fiiends, and to Ins 
pupils at St Bartholomew’s Hospital, to which he was then Physician, but 
no notice, I believe was taken of Ins lemaik in any book, befoie it appealed 
in the second edition of Di Baillie’s il/m hid Anaiomy, which was published 
in 1797 No snnilat obseivation, as fai as I know, is to be found in any 
book wiitten befoie that time Morgagni, indeed, and Di Feiiiai of 
Manchester, had given cases of iheumatism CMsting with an oiganic disease 
of the heait, but it is evident that they eonsideied tlie concniience of the 
two diseases as meielv accidental, and it is veiy piobable, that similai 
eases occui in otliei autliois ivlio wiote befoie Di Bailbe, thougli I have 
not met with them 

Since the appeal anee of Di Baillie’s woik, this disease has been tieated 
of by Di Odiei, of Geneva, in his Mamicl dc Medicine Piachqiie, punted 
in 1803, and by Mi David Dundas, Seigeant Suigeon to the King in a 
Paper lately published in the Ti ansacUons of the Medical and Siugical So- 
ciety of London Dr Odiei 's work is only a text-book foi Lectuies given 
by him on the Piactice of Medicine, and as is common in such woiks, A^eiy 
few references aie made in it to othei authors As he received, however. 
Ins professional education in this country, and has long conducted the 
medical department of the Bibliotheque Brrtannique, a literary journal 
printed in Geneva, he could not be unacquainted with Dr Baillie’s Moihid 
Anatomy Mr Dundas takes no notice in his paper of what had been said 
upon the subject of it, either by Di Baillie or Dr Odiei He could 
scarcely, indeed, have seen the Manuel of Di Odiei, and it is probable, 
that he had not read the account, which was given of it in the Edtnhwgh 
Medical Joutnal, for October, 1806, but there is a greater difficulty in sup- 

»Read April 3 1810 Published in Tr Soc Improv Med &, Chlr ICnowledge 3 373-424, 
1812 


[ 294 ] 


posing, that he was ignoiant of what had been mentioned, twelve yeais be- 
foie, in Di Baillie’s popular work, lespecting Eheumatism of the Heart, 
on the anthoiity of Dr Pitcaiin 

As I knew that Di Pitcaiin did not mean to publish anything upon 
this disease, and as I had good leason to believe, that it was unknown 
to many piaetitioneis of medicine in this countiy, I foimed the design, 
about foui years ago, of ofteiing a Papei upon it to this Society But 
veiy shoitly aftei, I saw the aiticle in the Edxnbuigli Medical Jownal, 
which 1 elates to Di Odiei’s book, and, in consequence, deteimined not 
to pioceed, till I should see the woik itself In the meantime, Mi 
Dundas’s Papei appealed, and this I found to eoiitam so much informa- 
tion upon the subject of which it tieats, that I necessaiily regarded the 
value of what I had collected myself as much diminished, and therefore 
abandoned the design of communicating it But consideimg afterwards, 
that even a i epetition of what had been ali eady said might be useful, in 
exciting the attention of physicians to a disease hitherto little spoken 
of, I lately lesumed my intention, and now offer, in the form of Cases, 
what I have aequiied fiom other souices than Mr Dundas’s Paper, as 
our knowledge of the disease is still too imperfect, to admit the formation 
of a just history of it I once expected that my Paper would be enriched 
by the contiibutions of my late most excellent friend Dr Pitcairn, for 
although I knew that he had preserved no account in wilting of what 
he had seen in this disease, yet I was confident, that the extent of his 
obseivation, for he had treated more than a dozen cases of it, and the 
accuracy of his memory, would enable him to afford me much valuable 
information But I neglected to obtain this while the opportunity 
existed, and I now lament my indisci etion 

CASE I 

Mr T M came from Scotland in Apiil, 1798, to reside in Berkshire, 
being then in his eighteenth year He was of a fan complexion, short 
stature, and a habit rather full than muscular Prom the age of nine 
years he had been every year attacked with acute rheumatism Pour 
of the attacks had been veiy severe, each of them confining him to bed 
for several weeks , the others seldom kept him at home longer than a week, 
though the ledness, swelling, and pain of the joints did not leave him for 
two 01 three weeks more While he was labouring under this disease, 
the pains often shifted in the most sudden manner, and, in the greater 
fits of it, he was often distressed with a sense of oppression in his chest, 
flightful dreams, and despondency of mind In November, 1797, he had 
likewise had a slight spitting of blood 

Pour weeks after he came to Berkshire, he fell into a small pond of 
water, while attempting to leap over it, and wetted his lower limbs as 

[ 295 ] 



fai up tib the nuddle oi his thighs lie jniisiied, howcvei, his exeieise 
and suffeied his clothes to diy upon him 'I'iie following day, while 
walking in the stieets ol Oxloid, he was suddenly seized with tiemhhng 
and coldness, piincipally aflecting his lowei limbs, with faintness, giddiness, 
sickness at tlie stomach, and a sense oi oppiession in liis chest He aftei- 
waids became waim, and then began to ieel a palpitation of his heart, and 
a beating in his head In the piogiess of his illness, he was fiequently 
attacked with bieathlessiiess, a sense oi choking, and a feeling as if he 
weie about to expiie In the night time he used to be waim, and to sweat 
After he had been aftected in this way about tliiee weeks, he came to 
London and consulted me At his fiist visit, I did not become acquainted 
with all the eiieumstaiices which I have mentioned, and as I found his 
pulse frequent, and tongue white, and was told by him, that he was woise 
eveiy othei day at ten o’clock in the ioienoon, I thought it piobable, 
that his disease was a tertian feiei, which had not yet fully intermitted 
As I learned, howeyei, when I saw him next, that the heating in his chest 
was never absent, though at some times much gi eater than at otheis, arrd 
that he had beerr mrreh sub]ect to rheumatism, I began to suspect, that 
his disease might be iheuinatism of the heail, of which I kneiv nothing, 
except what I had learned iioin Dr Baillie's ])ublication I carried him 
therefore to Dr Pitcairn, who eoiiftimed my eonieetuie, and was fearful 
that he would not recover 

Ml M went again into the countiy , but I had fioquent letters respect- 
ing him and once visited him there I think it, however, unnecessary to 
say more upon his case, than, that, after he had laboured under the 
palpitation four months, he was attacked with pains, swellings, and red- 
ness of his loints, Avhieh continued about six weeks, but weie not so 
severe as to confine him to bed, that dui ing this time the palpitation be- 
gan to lessen, but that it did not entirely leave him before the end of 
the second year from its commencement Mr M during his illness was 
several times seen by Dr Boirrne of Oxfoid He was seen also by Mr 
James Russell, of Edrnburgh, who had often attended him in sickness 
in Scotland, and having been called by business to Birmingham, had 
aftei wards extended his journey to Berkshire to vrsit him 

Since his recovery I have met rvith him fiequently, and have several 
times applied my hand to the region of his heart, without feeling there 
any unusual beating But he says, that exercise is now more apt to 
excite palpitation than formerly, and that he sometimes experiences it 
without any apparent cause lie thinks too, that it occurs oftenei while 
he is aftected with iheuinatism of the joints, which continues to attack 
him every year, than at any other time Before the palpitation comes 
on, he IS seized with a gnawing pain in the region of the heart, and a 
seime oi suffocation In two or three minutes these symptoms either 

[ 206 ] 



disappear, oi become less, llie palpitation then begins, and lasts about tbe 
same time Such attacks, liowevei, do not happen oftenei than twice 
01 till ice in the yeai 

I may add, that in the couise of my eon espondence with the lelations 
of Ml M I learned, that one of his uncles, whom he lesembles m external 
appeal anee, aftei being seveiely afflicted with iheumatism, became, when 
about sixteen oi seventeen yeais old, subject to violent palpitation of the 
heait, and some time aftei died suddenly and that, his body being 
opened, the heait was found enlaiged 

CASE II 

Maltha Clifton, aged iieaily fifteen jmais, was admitted into St 
Thomas’s Hospital, on the 18th of Febiuaiy, 1802, aftei labouring undei 
acute iheumatism about sixteen days Ilei pulse was small, but the heait 
stiuck the libs with such foice, that its beats could be leckoned by 
applying the hand to the light side of the chest About two or thiee 
yeais befoie, she had likewise been affected with acute iheumatism, 
duiing the piesenee of which she had been tioubled also with a violent 
beating of hei heait In the inteival between the two attacks of iheumatism, 
she had expeiieneed no palpitation in hei chest The account of what I 
did not obseive myself I received fiom the patient, and hei mother, but 
those, who aie eonveisant with the business of an Hospital, know that 
little dependence is to be placed upon the aceuiacy of patients oi then 
friends, when they speak of symptoms which have foimeily oecuired 
She lemained in the Hospital eleven weeks, and was then taken away by 
hei lelatioiis, foi the puipose ol being sent into the countiy The pains 
in hei limbs weie iieaily gone, and the palpitation of hei heart was much 
diminished 

Many of the tendons of the supeificial muscles in this patient were 
studded with numeious small hard tumouis, an appeal ance I have ob- 
seived only in one othei peison, a thin and feeble man foity-one yeais 
old, who also laboiiied undei iheumatism 

CASE III 

Chailes Williams, aged twenty yeais, was received into St Thomas’s 
Hospital the 21st of June, 1804, on account of painful swellings of his 
joints, undei which he had labouied seven months His pulse was quick, 
and his heait beat forcibly against the ribs He had often, he said, in 
the course of the last eight yeais, been affected with a similar disease of 
the joints, duiiiig which he had always been tioubled with a palpitation 
of his heait Aftei lemainmg a month nr the Hospital, without leeeiviiig 
much benefit, he was disehaiged fiom it foi disoideily conduct 

*Di L,istei has mfoimecl me that the supeificial tendons of Salmon the subject of the 
se\enth case in this Papei -were similarli affected As Salmon did not mention this to 
me and as I did not disco\er it mi self the same symptom mai haie existed in seieral 
of mi patients labourim; undei iheumatism, besides those of i\hom I haie spoken 

[2P7] 



CASE IV 

Maiy Bond came into St Thomas's Hospital on the 9th of Janiiaiy, 
1806, laboiuing undei acute iheumatism, winch liad seized her eight 
daj^s befoie Slie was then in liei sixteenth yeai, had nevex menstiuated, 
and since hex ninth ye.n had been frequently attacked with iheumatism 
When she had been tliiee months in the Hospital, I diseoveied, that hex 
heart beat much too strongly, and I was afterwards informed by her 
mother, that this symptom had always been present, while she was 
afflicted with rheumatism, but at no othei time She staid in the Hos- 
pital nearly four months, in the whole, and during that time frequentlj'' 
complained of pains in her chest Tlie.se, in the month of Apiil, were 
attended fox ten days with cough, difficulty of breathing, and an increase 
of fever When she left the Hospital, the pains in her limbs were not 
entirely gone, and her heart was still beating stiongly Possibly, how- 
eyei, as the pains of her limbs had lessened eonsideiably in the time be- 
tween her coming into the Hospital, and the discovery of the palpitation, 
this symptom had also diminished in the same inteival I learned its 
existence from inquiring, if she was aftected with it 

CASE V 

I visited Miss A L for the hist time, on the 17th of September, 1806, at 
her father’s house in Surrey, distant about eight miles fiom London 
She was sixteen j’-eais old, tall, and thin, and had nevei menstiuated 
Several of her relations had died of pulmonary consumption, and she her- 
self had laboured under an acute disease of the chest about four years 
before From that time, however, to the commencement of the tram of 
ailments which I am about to describe, she had enjoyed very good health, 
and had possessed a much gieatei degiee of bodily strength, than was 
indicated by her appear anee 

In the beginning of August, shortly after remaining some time in a cold 
cellar, she was seized with pains, swelling, and redness of her joints, and 
fever These symptoms lasted only ten days About a week after they 
had ceased, she walked about a mile from her father ’s house, assisted by 
an attendant, and, while letuiiiing, accidentally wetted her feet In the 
evening of the same day, she was attacked with pains in her feet, which 
were not accompanied with swelling or redness These pains remained 
only a day or two, immediately upon their ceasing, her heart began to 
beat with considerable violence Her right hypoehondiirrm soon after 
became painful, and about the same time she began to complain of a pain 
in the tops of her shoulders Various other symptoms had also oecruied, 
but as no regular history of them had been kept, and as the most im- 
portant existed when I visited her, I shall proceed at once to give an ac- 
count of the situation in rvliieh I found her, at the distance of nearly 
four weeks from the second attack of external pains 

[ 298 ] 



The palpitation of the heart, which had nevei ceased from its first 
appearance, was distinctly felt in eveiy part of the thorax, to which my 
hand was applied In the aiteiies, only a shaking was peiceivable, which 
could not be divided into distinct pulsations The strokes of the heart 
were one hundred and ninety in a minute , they were equal in force, and the 
intervals, which were also equal, were so distinct, that I fancied I could 
have numbered the strokes, if two hundied and fifty, oi even three hundred, 
had been given in the same time Hei breathing was not laborious, and 
she had no cough, but she fiequently complained of a great and in- 
describable anxiety in her chest This was always much lessened by her 
takmg a few drops of laudanum and a drachm of vitriolic aether, although 
no change was ever induced by these medicines on the palpitation The 
external jugular veins were swollen, and alternately rose and fell She 
had a little headache, was often sick at the stomach, and sometimes 
puked, what was thiown up was foi the most pait green, and had a sour 
smell Hei appetite for food was, notwithstanding, far fiom being lost 
The tongue was somewhat foul, and a small part of its middle was dry, 
but her thirst was inconsiderable She had two or three stools daily, 
their coloui had formeily been green, but was now natural There was 
now no pain in her shoulders, nor any in her right hypochondrmm, 
except it was pressed On the day I visited her, the skin and eyes had be- 
gun to be a little yellow, and her urine, which was said to be sufficiently 
copious, now gave a slightly yellow tinge to white linen On examining 
her feet, I found them oedematous Her, muscular strength was greater 
than might have been expected, considering the length and magnitude of 
her ailments 

I staid all night at her father’s, and saw her early on the following morn- 
ing, when I was astonished at learning, that soon after taking fifteen drops 
of laudanum, late in the evening, she had become quiet, had remained 
so the whole night, and had enjoyed much refreshing sleep The uiine, 
which was passed in the mght, had a pink-coloured sediment In the 
other symptoms there was no change 

On the evening of the 19th, I visited her again, and was accompanied 
by Di John Meyer, of New Bioad-street The day before, she had been 
thought bettei , but many things seemed now to indicate her speedy death 
The sickness had inci eased, hei face and hands were cold, the skin pale, the 
motion of the aiteiy at the wrist scarcely peiceptible, and the strokes of the 
heait against the iibs of much less foice than foimerly Their numbei was 
a hundied and seventy in the minute She shewed, however, no sign of 
weakness of mind oi of delirium, and hei tongue was moist and clean 

Illy last visit was on the 21st Shoitly aftei Dr Meyer and I had left 
hei on the night of the 19th, she had vomited a consideiable quantity of a 
thin fluid, mixed with a less quantity of a thick and veiy black fluid, after 
uhich she became bettei I could again distinctly peieeive motions in the 

[ 299 ] 



ditenes, though tliey weie not to be leckoned The beats of the heait weic 
one hnnclied and sixty m the minute, and weie felt only in the left side 
of the chest The skin of the whole body was waini and moist, that of 
the neck and chest was paitially coi^eied with a miliaiy eiuption Her 
bowels had been seAeial days bound, except when loosened by gtysteis 
The abdomen was somewhat swelled, and piessiue upon it gave moie 
pain than at my fiist visit She was diowsy, but this was attiibuted to 
some laudanum nliich she had taken She had lately spitten a little blood, 
but she was still without a cough Resjiiiation, likewise, was peifoimed 
with little difficulty, and took place only twenty-five times in a minute 

On the following night, as I was afteiwaids infoimed, she was lestless, 
which was attiibuted chiefly to the inflamed state of the skin of the 
chest, fiom a bhstei which had been ajiplied seveial clays before She 
complained fiequently in the night of pains in her legs and feet She 
took, howevei, a eonsideiable quantity of food, and hei bieathings, being 
leckoned, were found to be only lwent3’--two in a minute, although there 
was no diminution in the mimbei of the beats of the heait In the 
moiiiing, she began to be inattentn e to what was passing in her loom, and 
to speak sometimes a little incoheiently At two o’clock in the afternoon 
she died suddenly 

I had pieyiously lequestecl a fiicncl of the family to apply, when death 
should oeeui, for pei mission to me to inspect the body Application 
was aceoidingly made, and peimission obtained But some mistake vas 
committed with lespect to mfoiming me of what had happened, and the 
weather being waim, and the family anxious to ha^e the examination oiei, 
this was perfoimed by the apothecaiy who had attended the deceased, 
assisted by his partner, and another medical gentleman Had I been 
present, the younger Mi Cline would hare conducted the examination, as 
he had been kind enough to promise to accompany me for that pin pose 
The following are the piincipal moibid appeal ances, which, as I was 
afterwards informed, were observed 

The pleura of the ribs, and that of the lungs, were inflamed, and m many 
places adhered to each other The lungs felt firm and fleshy, from con- 
taining a quantity of coagulated blood The ivhole of the mteinal surface 
of the pel icai drum nas attached to the heart, by means of two distinct 
layers of solid matter , each having the thickness of a shilling , the outer 
lesembled coagulated blood, while the inner was whitish, and sufficiently 
tenacious to permit its being tom The surface of the heart was also in- 
flamed, and, from the right auricle to the apex, black, its substance ivas 
flaccid, and appeared to be enlarged About a pint of bloody serum was 
found 111 each cavity of the chest A considerable quantity of fluid, slightly 
red, was likewise found in the abdomen The right lobe of the liver was 
enlarged, and much inflamed, and, on its concave surface, black The 
stomach, where in contact with the liver, was also black, and many parts of 

[ soo 1 



It had maiks of mflanimation Maiij'- poitions of the small intestines were 
inflamed, and the lower half of the rectum seemed to be gangrenous I 
must remaik, howevei, that what has been said of the stomach and in- 
testines relates onty to then external appearance, for no pait of them 
was opened 

CASE VI 

John Miller, a sailor aged thirty-six yeais, pale and thin from bad 
health, was admitted into St Thomas’s Hospital, on the 1st of June, 
1809, on account of pains m his limbs, with which he had been afflicted 
five months His pulse was frequent and rather feeble, and during the 
two last months he had felt a constant beating in his left side, which upon 
examination I found to depend upon the action of the heart He re- 
mained in the Hospital two months, in which time he became free from 
pain in his limbs, and in a gieat measuie lecovered his flesh, but the 
pulsation in his side, which had nevei been veiy gieat, continued un- 
changed He now thought himself sufficiently well to go to sea, and was 
disehaiged fiom the Hospital at his own desire 

CASE VII 

George Salmon, at present in St Thomas’s Hospital, a domestic servant, 
nineteen years old, of a fan complexion, shoit stature, and while in 
health fresh-coloured, and inclined to be fat, but now pale and thin, 
became the patient of my colleague, Di Listei, on the 11th of January 
last From the notes which Di Lister has been kind enough to com- 
municate to me, and fioiii my own examination of the patient, I have 
collected the following ciicumstanees of his case 
In June, 1808, thiee days after being heated in a playhouse, and drink- 
ing while in this state a consider able quantity of porter, he was attacked 
with stiffness, pains, and weakness m his limbs, and with pains and swell- 
ings 111 the joints of his fingers Duiiiig this illness he also laboured, 
foi a fortnight, undei a pain of the light side of his chest, and a cough 
111 the couise of three months the ailments in his joints became much 
less, but he did not entirely recover his health foi nine months nioie, 
duimg which time he used to feel a beating m his foiehead after lun- 
niiig, and often had the joints of his fingers swelled for three or four 
days He lemained peifectly well to the middle of December, 1809, when 
he was seized with stiffness, and slight pain m his lower limbs, attended 
u ith a rash, and feveiishness The i ash occupied vaiious parts of his skin 
111 succession, but was iievei veiy extensive, and receded in a week It 
has since been several times present foi a day, but has not appealed foi 
the last SIX weeks Shoitly aftei the beginning of his illness, the joints 
of the fingeis began to swell again, and to be painful when pressed, in 
which state they still continue Sometimes they are slightly led, and the 
back ot his iiglit hand was latelv sw^elled, and a little led, foi a few 

[ 301 ] 



days The stiffness and pain of liis lower limbs began to decrease soon 
aftei he came into the Hospital, the foimei is now neaily gone, and the 
lattei has not been felt by him foi a foitnight In the first part of his 
stay 111 the Hospital, he was attached with a pain in his left side, which 
was increased when he diew his bieath, this lemained about foiiiteen 
days, and he has lately been fieqiiently tioiibled with a slight cough 
Since his admission into the Hospital, it has been discovered, that his 
heait paljiitates He does not know that he labouied befoie under this 
symptom, but this seems no pi oof of its not having existed, foi he is still 
seaieely evei conscious of it, fiom any internal feeling While he is 
sitting or lying, the palpitation is often not to be peiceived fiom apply- 
ing the hand to his left side, but as soon as he uses it becomes very 
evident The pulse vanes in point of niimbei veiy consideiably, but is 
geneially between ninety and a hundied The stiokes aie full, but aie 
easily made to Amiiish by piessuic Each stioke is given lapidly, as if 
with a Jiik, foiming, I think, what Moigagiii calls the vibrating pulse, 
and which so fiequentW oeeuis in diseases of the heait, paiticulaily at 
then commencement, and in acute iheumatism His skin is cool, but at 
night, he says, his feet often bum Ills tongue is a little white, his 
appetite much diminished, his bowels open, his mine is of a deep stiaw 
coloui, but does not become tuibid b 3 ^ cooling He has no difficulty of 
breathing, except what he attiibutes to weakness, and his head is fiee 
from pain and uneasy feelings He sleeps little, but is unable to assign 
any i eason foi it ' 

Having finished the desciiption of the cases seen bj’' mj’^self, which I 
think may be piopeily aiianged undei the title of iheumatism of the 
heait, I shall next i elate seveial moie, the knowledge of Avliich I have 
deiived fiom othei souices 

CASE Vlll 

This has been fuinished by Di Baillie, and Avill be given in liis OAvn 
wolds 

“Blaich 25, 1807 

“A boy about ten years old, of a fan complexion, and iiiitable constitu- 
tion, who had a sciophulous scai under the left side of the lover jaiv, aftei 
labouring many months undei iheumatism, vms attacked Avitli palpitation 
of the heart, and some time aftei died He ivas attended by Di Vaughan, 
Dr Reynolds, and mj’'self His body was examined, but I was not piesent 
The heart, as I have been infoimed, v^as someivliat enlarged, and there was 
a strong adhesion of the peiieaidium to it He had a few tubeicles of the 
lungs, and I believe some of the glands of the mesentciy iveie enlaiged 
The liver was also of a greatei size than usual ” 

»This patient left the Hospital a daj oi t^o aftei his case was taken bj me 

[302] 



In anotliei communication, dated m April, 1809, Di Baillie says — ‘‘I 
have known a good many instances of palpitation of the heait in childien, 
and young people of both sexes I cannot, however, now lemember dis- 
tinctly more than thiee oi foui, where this affection was preceded by 
rheumatism But I can liaidly doubt that seveial cases of this kind have 
been toi gotten by me ” 

CASE IX 

I leceived this fiom my colleague, Di Listei 

“Miss P , thiiteen yeais of age, became my patient on the 17th of 

May, 1807, at which time she laboured iindei a very considerable difficulty 
of bieathing, and a iialpitation of the heait so violent, that not only the 
motion it gave to hei clothes might be seen at a distance, but hei body 
itself was shaken by it Both these symptoms weie inci eased by the 
least exeieise She had a slight cough, hei countenance discovered great 
uneasiness, hei pulse beat a hundred and thirty-six times in a minute , the 
tongue was white, the appetite was less than natural, the bowels were 
confined, the mine was in the usual quantity She was emaciated, and 
her emaciation was said to have taken place dining hei present illness 
I was infoimed, that she had been attacked in the beginning of the 
pieeeding Febiuaiy with acute iheumatism, which lasted about a fort- 
night, and that, when this left her, the shortness of breath, palpitation 
and cough came on At first the cough was very considerable Her 
feelings became less uneasy, and her pulse slower, under the use of a 
spare diet, and of a blister applied to the region of the heart The 
alleviation of symptoms occur red too quickly to have been the effect of 
digitalis, which she was taking at the same time On the 25th, the feet 
began to be oedematous , on the 29th the abdomen was swelled, and a 
fluctuation was to be felt in it On the 5th of June, the anasarea was 
general, the swelling of the abdomen was increased, the pulse in- 
termitted, and was slower On the 6th, in the morning, the swelling of the 
abdomen was lessened, and the patient thought herself much better In 
the evening, she was suddenly seized with extreme difficulty of breathing, 
and an occasional suspension of breathing, while the breathing was sus- 
pended, the pulse eithei did not beat at all, oi beat very slowly On the 
7th, at two o’clock in the moiiiiiig, she died 

“Leave having been obtained foi examining the body, the examination 
vas made by my fiiend hli Smith, of Southampton-stieet, on the 8th 
of June, and the following is the account he vas so good as to give me of 
the appearances he observed 

“The lungs adhered to the pleuia costalis almost at eveiy part The left 
side of the chest contained about five ounces of v atei , in the right side there 
nas about one ounce The peiicaidium adheied to the whole surface of the 
heart, the adhesion vas easilj separable Iw means of the fingers The 
heart vas twice as laige as natuial, its musculai stiuctuie was increased in 

[303 1 



thiclmess, and all its cavities weie veiy imieli loaded with blood The 
cellular membiaiie of the lungs contained some watei In the cavity of the 
abdomen theie was about a pint of watei, in which weie floating seveial 
poitions of coagulable lymph The visceia of the abdomen weie free from 
disease ” 

CASES X and XI 

Both of these have been communicated to me by J\Ii Benjamin Biodie, 
Assistant-Suigeon to St Geoige’s Hospital 

“A gill, foul teen yeais of age, was admitted into St Geoige’s Hospital, 
in the middle of Apiil, 1807, with symptoms of acute iheumatism affecting 
the extiemities These symptoms in a shoit time subsided, but weie im- 
mediately succeeded by pain in the chest, attended with a sense of op- 
piession in bieathmg, palpitation of the heait, a quick feeble pulse, and 
geneial debility On the 23d of May she died 

“On inspecting the body, the lung on each side was found adlieiing to 
the pleiiia lining the iibs, but the adhesions weie not of a leeent date 

“About twelve ounces of seious fluid were effused into the cavities of the 
chest 

“The peiicaidium vas much inflamed, and the tvo folds of that mem- 
biane weie united by a layei of coagulable lymph ” 

“A woman, twenty-flve yeais of age, was admitted into St Geoige’s 
Hospital, undei the caie of Di Nevison, in July, 1807, labouiing undei 
diopsj^ of the abdomen, anasaica of the lovei extiemities, and a constant 
palpitation of the heait She said, that some months pievious to hei ad- 
mission she had been attacked with a iheumatic fevei , that, on the fevei 
subsiding, she was seized with the palpitation of the heait, which had 
continued evei since, and that the diopsieal symptoms had appealed moie 
latelj'' She died a few weeks aftei hei admission 

“On inspecting the body, the lungs weie found paitially adheiing to the 
mediastinum Theie weie adhesions eveiy wheie between the two folds 
of the peiicaidium On the internal suiface of the left auiicle of the heait, 
theie was a space, of about an inch sqiiaie, studded with veiy minute 
excrescences lesembliug small waits Three exciescences of a laigei size 
were found on the internal suiface of the left ventiicle, about an inch below 
the semilunai valves One of these was so laige, as to pioject about half 
an inch into the cavity of the ventiicle Two oi thiee similai exciescences 
weie attached to the mitial valve, and semilunai valves of the aoita ” 

CASE XII 

This case was oiiginally published in the London Medwcil Jowncd, foi 
April, 1803, by Mr Wagstaffe of Southwaik, in -whose piaetice it had oc- 
euiied As it appears to me valuable, foi this, among othei reasons, that 

[ 304 ] 



tlie body was examined aftei death by a teachei of anatomy, Mi John 
Tannton, I shall heie give an abridgment of the oiignial account of it 
Miss M aged about foniteen yeais, of a spaie habit, sallow complexion, 
and active disposition, became the patient of Mr Wagstaffe, in the middle 
of Januaiy, 1802, on account of her labouring under acute iheumatism 
After continuing lU in town foi nearly two months, she went into the 
countiy, whence she leturned in a short time, apparently in good health 
She remained well till the beginning of Octobei, when she was again at- 
tacked with acute rheumatism This disease disappeaied in about a week, 
leaving a most distiessing cough, an excruciating pain in the left side, 
palpitation of the lieait, and difbcult lespiiation, attended with great dread 
of suffocation The pulse varied from a hundred to a hundred and forty 
in the minute, it was sometimes throbbing, at other times weak Blood 
taken from the arm, at this period of the disease, exhibited but slight marks 
of inflammation In a few days the respiration grew moie difficult, and 
the patient now began to be sometimes affected with vomiting Her situa- 
tion aftei waids became much less distressing, apparently in consequence 
of medical treatment, but the amendment did not continue long, and she 
died in gieat agony on the 23d of November 
On opening the body, stiong and extensive adliesions were found be- 
tween the lungs, and the adjoining parts, but the lungs themselves were 
sound The perieaidium was attached so closely to the heart, that it was 
veiy difficult in most places, and m some quite impossible, to separate them 
The heait was enlaiged, but its stiuctuie was natuial The abdominal 
visceia weie in a healthy state 


The pieceduig eases appeal to me just instances of iheumatism of the 
lieait The two which follow are less so, but seem, notwithstanding, suffi- 
ciently connected with my subject, to excuse my relating them 
Philip Smith, aged fifteen yeais, feeble fiom his biith, became a patient 
111 St Thomas’s Hospital, on the 9th of July, 1807 In 1804, he had 
labouied iindei acute rheumatism four months Two yeais after this, he 
was seized until a fevei, which lasted also four months During the fever, 
his heait liegan to beat more stionglv than foimeily, and it continued to do 
so ever aftei Piom the time of his recovery fioni the fever, he had often 
felt pains, chiefly at night, in his lowei limbs The fiont of his head 
almost constantlj^ ached, and blood had twice lately flowed from his 
nostrils His face was fiequently flushed, and sometimes appeared to 
him a little swollen After he had been a foitnight in the Hospital, he was 
attacked with a pain in his light side, and a cough He was an only child, 
and his fathei was so unhappy while they weie sepaiated, that he took 
him home on the 30th of July 

Mr E of Canteibiiiy, about twenty-foui yeais of age, of a fan com- 
plexion, and stout make, after being long constantly afflicted uitli iheu- 

[3051 



matism, eithei in its acute oi clnonic foim, became subject to attacks of 
extreme difficulty of bieathmg, and a sense of tightness aeioss Ins chest, 
attended with a pulse alwaj’-s fiequenl and small, and sometimes inegulai 
These attacks had of late oeeuiied about once a month They were fre- 
quently preceded by a slight inflammation of the fauces, and weie some- 
times accompanied Avitli inflammatoiy sivellmgs of the joints, but never with 
cough, 01 pain in the chest Wlien the difficulty of bieathmg was most 
urgent, no motion was peiceptible in tlie abdomen fi om lespiiation Such 
was the account of Mi E’s disease, which I leeeived in Septembei, 1806, 
from his medical fi lends in Kent mA" oaaui examination of him I 

learned, that in his best stale lie had a constant uneasiness undei his 
steinum, AAfliich Avas inci eased by a deep mspiiation, that he had often a 
beating of his heait Avhile he Aims at lesl, and ahvays aftei he had Avalked 
a little quickly, Avhen it Avas attended Avitli bieathlessness, that his pulse 
Avas fiequent, and that liis uime AA'as highl}’- colouied AA'hen fiist made, and 
became tuibid on cooling A montli aftei he consulted me, I Avas informed 
by one of his medical fi lends that lie AA'as bettei , and tlie folloAA'ing yeai 
I Avas told, by a peison Avliom lie sent to me, tliat he Avas altogethei AveU 

I think it propel also to mention heie, that I have seen foui persons die 
of peiipneuinony, Avhich had supeivened to acute iheumatism The heart 
of one of them, a sailoi boy, fouiteen yeais old, beat Avith more than 
oidinaiy foice, AA'hile he labouicd undei the disease of his chest In an- 
other, a female servant, nineteen A’^eais of age, a patient of Di Lister’s in 
St Thomas’s Hospital, the heait palpitated strongly in the beginning of 
the peiipneumony Hei body being opened, along AA'ith other marks of 
disease in the contents of the chest, the peiicaidium AA'as found to adhere 
in various places to the heait The heait Avas not enlarged , but its muscular 
substance Avas in seA'eial places inflamed Permission could not be obtained 
to examine the bodies of any of the other three patients In aU the four, 
the disease of the limbs eithei had become less, shoitly before the acces- 
sion of peiipneumony, oi Avas eoiisideiably diminished very soon after 
Several other examples have been seen by me of an attack of peiipneumony, 
in persons affected Avith acute rheumatism, but in these the patients re- 
covered 

To render the historical part of my subject more complete, I shall add, 
that, in Ml Burns’ OiservaUons on the Diseases of the Heait, there is an 
account of a girl affected AVith palpitation, aa'Iio, among other symptoms, 
had frequently shifting pains in several of the large joints, and had 
formerly laboured under rheumatism, that, in the Nineteenth Number of 
the Edmbwgh Medical Journal, an instance is related by Mr Crowfoot of 
acute rheumatism, in a tall feeble man, about tAventy-tAvo years of age, being 
attended with sj'mptoms of a diseased heart , and that of the three eases of 
carditis, Avhich have been published by Dr Davis, in his treatise on that 
disease, the first occurred in a girl tAvelve years old, Avho had laboured eight 

[ 306 ] 



days under pains in liei left slioiildei, and insteps, before any symptom of 
a diseased heart appeared, and became fiee fiom those pains the second 
day after the accession of such symptoms , the second, m a boy seven years 
old, who suffered acute pains in the lower extremities, during different paits 
of his illness, and the thud m a girl sixteen years of age, the disease of 
whose heait succeeded the sudden disappeaiance of inflammation in hei 
feet and ancles 

In legard to the treatment of rheumatism of the heart, the propriety of 
enjoining rest and low diet in the beginning of it, and, in every stage, of 
pioducing a discharge of serous or purulent niattei fioni the integuments 
of the thoiax in the neighbouihood of the heart, by the use of cantharides 
or other means, will, I believe, be admitted by every person But, when 
the tendei age of those most liable to it, and their frequent wealmess, 
whethei original, oi consequential to the disease of the joints which had 
previously existed, are considered, it may often appear improper to bleed, 
even at its commencement Besides, as it has been found, that m London 
bleeding is never necessary foi the cuie of acute rheumatism of the ex- 
ternal parts, and sometimes proves highly injurious , and, as the translation 
of the disease to the heart seems analagous to the lecession of gout from 
the extremities , additional arguments may hence be derived against the gen- 
eral practice of bleeding, even m the very onset of the disorder My own 
opinion, however, is in favour of copious bleeding, in the beginning of the 
disease, notwithstanding the force of the arguments which I have related 
When the disease of the heart has quickly followed the entire disappearance, 
or considerable diminution, of that in the joints, we may attempt to bring 
back the latter, or to imitate it, by inducing inflammation m their integu- 
ments I followed this practice in the case of Miss A L , but she suffered 
so much distiess from the stimulating substances, which were applied to her 
joints, tliat her mother soon removed them , and, as her situation had from 
the first appeared to me hopeless, I thought it eiuel to urge their renewal 
If the disease assumes a chronic form, and there be evident signs of an 
enlarged heart, it should, in my opinion, be treated, as if the enlargement 
had never been connected with external rheumatism, in which ease. Dr 
Pei liar of Manchester has experienced beneficial effects from the use of 
tome remedies 

What has hitherto been sard of the method of cure relates, chieflj’', to the 
most eonsideiable eases of the disease In others of less magnitude, a 
different mode of treatment may sometimes, perhaps, be with propriety 
adopted, especially if they have been of long standing In the second ease, 
for instance, related by me, that of Martha Clifton, as I was informed that 
she had laboured under palpitation of the heart, in a former fit of rheuma- 
tism of the limbs, and that both diseases had left her at the same time, I 
applied mjsclf solelv to the removal of that in the limbs, expecting that the 

[ 307 ] 



other would recede with it, and the event paitly justified my practice, for 
they diminished together, though they lioth existed in some degree ivhen 
she left the Hospital I received similai inf oi matron legaiding the cessa- 
tion of the internal and external disease in the foimei attacks, which had 
been suffeied by the subjects of the third and fouith cases, and followed 
theiefoie a similai mode of piactiee On the same grounds, I employed 
meicury in the tieatment of John Millei, the subject of the sixth case, but 
unsuccessfully with respect to the lemoval of the palpitation 
To conclude, I take the libeity of calling to the lecollection of the Society, 
that the bodies of six of the peisons, whose eases I have related, were 
examined after death, and that in two of them the livei was found diseased 
I had supposed this to ai ise horn the impeded passage of the blood from 
the vena cava througli the lieait, and its consequent congestion in the 
vessels of the livei, but I ha\e lately learned, that Di Odier has seen 
iheumatism translated from the joints to that viscus The two instances, 
therefore, ot disease in the livei, to wlncli I have lefeiied, may possibly 
have arisen fiom a common cause with the disease of the heait and not have 
been the effect of it ‘ 


POSTSCRIPT 

Read November 5, IS 11 

Aftei the preceding Papei had been lead to the Society, tvo fiuthei cases 
of iheumatism of the heait oceuiied to me, which seem worthy of being 
made knowi to it 


CASE %m 

Charles Mills, aged sixteen yeais, was admitted into St Thomas’s Hos- 
pital, on the ITtli of August, 1810, aftei labouiing three days under pains 
ot his limbs He was of a feeble appearance, and, four years before, his 
light leg had been amputated, in the same Hospital, on account of a long 
disease of the ancle I saw him first at one o’clock in the afternoon of the 
18th His ancle was swelled, painful, and a little red His pulse was 
frequent, and his face flushed, and both the latter symptoms weie in a 
gieatei degree, as I then thought, than could be occasioned by the dis- 
ease of the ancle, though he complained of nothing else Thiee hours 


*Th6 following case which I met with after the piecechng Paper had been leacl to 
the SocieV, strengthens mj foimei opinion 

A sailor boy, seventeen >ears old, was received Into St Thomas's Hospital, June 6, 
ISll, aftei he had labouied foui months undei a pam in the legion of his lieait chfflculti 
of breathing and a slight cough His pulse ivas fiequent his heait beat somewhat too 
strongly especially when he stood oi walked and his lowei hnihs were a httle dropsical 
He lemamed nearlj in the same state till about the middle of August All the siraptoms 
of the disease in his chest then inei eased and he died on the 2d of September I hao 
never observed the beats of his heart and arteries to have, during any short space or 
time unequal force, ot to follow one aiiothei at unequal intenals No diseise of Uie 
limbs had preceded or accompanied that in his chest His bodj was examined the dy 
aftei his death The pleuia of the lungs adheied in many places to the plema of the 
ribs and between other parts of those membranes weie found about twelve ounces or 
a watery fluid The heart was enlaiged, but not considerabh The pericardium and 
the covering of tlie heait adhered eveij where so closely together that they could not 
be separated and scaicely any line of distinction could be peiceived between them ihe 
a nrtie valves -*^her lespects the heait was sound Both the iwer 

and snleen v substance appealed to be without disease The 

stomach and large A few ounces of a watery fluid were found 

also in the abdomen 

[ 308 ] 



aftGi wards, lie was attacked witli a pain in Ins left side, difficulty of 
bieathing, and a slight cough In tivo houis more, the pain in his side was 
increased, but that of the ancle was neaily gone At nine o’clock in the 
evening, the pain of the side, and the difficulty of bieathing, having be- 
come greatei, and his lieait having begun to palpitate strongly, six ounces 
of blood weie taken fiom his arm Aftei the bleeding, the symptoms 
were less for half an houi, at the end of which tune they became as con- 
siderable, as they had been befoie At four o’clock the next morning, 
the pain in the side was veiy great, and the palpitation violent The 
patient fieqiiently neaily fainted, and his pulse was one hundred and 
thirty in a minute Eight ounces of blood being now taken away, the 
palpitation and pain became less A blister was soon after applied to his 
left side The occuireiices after one o’clock on the 18th took place, while 
I was absent from the Hospital I saw him again at one o’clock in the 
afternoon of the 19th His breathing was then a little difficult, and his 
pulse one hundred and twenty m the minute, small, and hard, but the 
palpitation had ceased entirely, and the pain of his side had nearly 
ceased On the 20th, his pulse was one hundred and twelve, and was 
softer and fuller than on the preceding day, he had no pain either in his 
side or ancle, and no cough On the following day the palpitation was 
present several hours, and he complained of a feeling of tightness across 
his chest Eight ounces of blood were m consequence taken from him, 
and it was diieeted, that the blistered part of his side should be dressed 
with the ointment of canthaiides Prom this time I scarcely evei ob- 
served the palpitation to be entirely absent On the 28th his pulse was 
ninety-two, to which it had gradually fallen He complained this day of 
a pain in the right side of his chest, and on the 4th of September of pain 
in his ancle and left shoulder , but, m both cases, the pain lasted only a 
day 01 two The palpitation having increased considerably, and the pulse 
having become more frequent, eight ounces of blood were taken away on 
the 11th of September, though he had no pain in his chest During the 
whole of his stay in the Hospital, he had been restiicted to a low diet, and 
had taken as much tartarised antimony every six hours, as his stomach 
could bear without sickness being produced by it When his bowels were 
costive, a little Biisom salts had been given to him A discharge of serum 
or pus, fiom the skin of the left side of the thorax, had always been pre- 
sen ed On the 15th of September, the antimonial medicine was omitted, 
and he was ordered to take ten diops of the tincture of digitalis 
thiee tunes a day He used the digitalis for nioie than three weeks, 
and dining this time the pulse was mostly as slow as it is in a healthy 
person, and sometimes intermitted, but the palpitation of the heait 
was seaicely lessened in force On the 11th of October he left the 
Hospital I saw him thiee months afteinaids, at which time the 
strokes of his heait against the iibs weie moie fiequent, and much 

[ 309 ] 



stiongei, than they ought to have been, if he had been entirely well IIis 
external appeaiance, howevei, was nearly that of a healthy person He 
said, that he had now no ailment, and that, foi the most pait, he did not 
feel any beating at his heait, but that shortly after he went from the 
hospital he had been seized with a pain in his chest, which, howevei, left 
him soon, without his using any medicine I saw him again a few days 
ago, about a twelvemonth after he went from the Hospital He has be- 
come tallei, and moie lobust, and has the look of being in perfect health, 
and this he said he enjoys But I found his pulse to be one hundred and 
ten in a minute, and his heart to beat stiongly against the ribs The 
beating he imputed to his suipiise at seeing me, and he assuied me, that 
now he almost never expeiiences the slightest degree of it As I staid 
with him, however, half an lioui, and during the whole of that time per- 
ceived alteration in the action of the heart, I must conclude, at least, 
that a small degree of surprise produces a greater effect upon it, than 
would happen, if there did not exist in it some remnant of an organic 
disease 

CASE XIV 

Anne Warwick, a nursery maid, iii the twenty-first year of her age, was 
received into St Thomas’s Hospital, on the 14th of March, 1811, being 
then affected with acute rheumatism, which had attacked her a month 
before She had also pains in her chest, which I supposed to be seated 
in the external muscles, and a headach In the course of the two preced- 
ing years, she had twice laboured uiidei acute rheumatism, in a more 
considerable degree than at pi esent, but at both those times she was free 
from ailment in her chest The day after she came into the Hospital, she 
was seized with a pain in the region of the heart, on account of which 
a blister was applied to her left side The following day I found her 
heart to beat stiongly, which she said it had done nearly two days Her 
breathing was also difficult, but she had no cough Ten ounces of blood 
being taken from her arm, the symptoms of the disease in her chest were 
lessened, they encreased, however, on the moiiow, and again became 
less, after a blister had been applied over the sternum Her pulse was one 
hundred and forty in a minute, and she had now no pain in any limb 
except the right leg On the evening of the 18th, she was breathless, and 
had a great tendency to faint , but she did not complain of pain in her 
side or palpitation The disposition to faint was, indeed, always present, 
when the disease of the chest was urgent, and at such times she frequently 
did faint Twelve ounces of blood were drawn from her arm, and she 
soon became better On the 21st, the difficulty of breathing and palpita- 
tion returned, but ceased almost immediately after she lost ten ounces 
of blood I here mean by palpitation such a degree of beating of the heart 
against the ribs, as excited the patient’s attention, and was uneasy to her 
For I believe, that the heart, from the time of the first attack of the pam 

[ 310 ] 



m her side, had always beat much more strongly m her, than it oidinarily 
does in a person in health She lemained free from uneasy feelings in her 
chest till the 28tli, when she was attacked again with pain in the left side, 
and palpitation of the heait, both of which ceased on the following day, 
within two hours aftei twelve ounces of blood were taken from hei The 
pain of her side never returned, but she was often afterwards breathless 
and disposed to faint, particulaily when in an erect posture, but, as her 
strength had been much reduced by bleeding and othei cncumstances, these 
symptoms weie piobably occasioned only in part by the disease of her 
heart On the 31st, about an ounce of blood flowed fiom her nose, soon after 
which liei headaeh ceased, which had been almost constantly present fiom 
the day of hei admission, into the Hospital She continued long feeble, 
and suffered much fiom imiious ailments, duiiiig the lest of hei stay in 
the Hosiiital, which lasted till the 1st of the following June When she 
went away, she complained of nothing, but she was still weak, and her 
heait still beat strongly One of the nurses of the Hospital saw her about 
a mouth aftei wards, at which time she appealed to be altogether well I 
have no doubt, howevei, but that the action of hei heait was then too 
gieat 

I shall now mention several things lespecting this patient, which I have 
hitheito omitted speaking of, in ordei that the naiiatioii of the chief cii- 
cumstaiices of hei ease might not be mteirupted 

1 Foi the fiist foui weeks, the only medicines she took mteinally were 
lemon juice, neutralised by salt of tartai, and infusion of senna with 
Epsom salts Duiiiig the same time, a constant discharge, eithei of 
serous oi of puiuleiit niattei, from the skin of the left side of hei chest, 
was pioeiiied by means of caiitharides , but when she became feeble, the 
dischaige was allowed to cease, as the caiithaiides irritated her then con- 
sideiably At the commencement of the fifth week, she began to take the 
tinctiiie of digitalis tin ice a day, in doses of twenty drops, and she con- 
tinued its use eight days It seemed to pioduce no effect, eitliei upon hei 
pulse 01 hei stomach 

2 Her pulse, duiing the whole of hei stay in the Hospital, except upon 
one day^, was veiy fiequent, once, while she was in bed, it was a hundred 
and f orty-f oui m the minute , but its sti okes and intervals were always 
equal, except on the day to which I have just alluded It was then only 
seventy -six in the minute, and both the stiokes and intervals were veiy 
unequal It uas felt while she was in a sitting postuie, and she had not 
taken digitalis foi five weeks 

3 I have said that, m the fiist attack of the disease of her heait, she 
Imd no cough, no cough evei occuiied in the piogiess of that disorder, 
fiom which It seems piobable, that the inflammation did not affect any 
poi tion of the lungs 


[ 311 ] 



4 Aftei she had been a month in tlie Hospital, I discovered an eruption 
on the skin of hei chest, aims, and hands, which I pionounced positively 
to be the itch It went away, howevei, in tliiee weeks, without any means 
being employed to remove it 

5 Five weeks aftei she came into the Hospital, she complained of her 
thioat being painful A few days aftei waids, I peiceived her bieath to 
smell, as if she weie in a salivation fiom the use of meieiiiy, her tongue 
at the same time felt soie, and had white spots upon it Saliva also lan 
fioiii hei month, though in no gieat quantity She had used no mercury, 
in any foim, while in the Hospital This state of hei mouth lasted neaily 
tliiee weeks, and caused hei to become feeble, chiefly by pi eventing hei 
fioni taking food Small doses of Peiuvian baik iveie now piesciibed 
foi hei, and she was allowed a little poitei Hitheito she had been 
kept on a low diet, and had been debaiied the use of all feimented 
liquois 

6 Immediately aftei hei mouth had become well, and as hei strength 
was 1 etui mug, hei feet and legs began to be diopsieal, but hei progress 
towaids lecoveiy did not seem to be letaided bj’- this event, and the 
swellings disappeaied in the space of ten days AVhile they weie piesent, 
she took Giiflith’s mixtiiie of non, myiih, and salt of taitai 

7 The pains in hei limbs, which weie said to have neaily ceased at the 
time she was fiist seized ivith the pain in hei side, nevei letuined with 
any violence Indeed, while the disease of hei chest was most considei- 
able, they weie sometimes entiielj' absent They inci eased a little, when 
the disease of the chest became less, but left her altogethei a few days 
befoie she went out of the Hospital 

In both of the piecediiig cases, the geneial health of the patients seems 
to have stiff eied fioiii the means which weie emiiloyed to oveicome the 
internal inflaiiiniation , but, I shall not hence be deteiied, fiom using the 
same means in an equal degiee, in any similar case that may heieaftei 
occui to me The palpitation, which lemained in both patients so long 
aftei the violence of the disease had been subdued, piobably depended, 
in pait, upon some relic of inflammation m the immediate coveimg of the 
heart, and, in pait also, upon the lieait being nutated by the adhesion of 
the pericardium to it As the palpitation, howevei, entiiely ceased, in the 
couise of time, in Mi T M the subject of the flist Case in the foiegoiiig 
Paper, it is to be hoped, and peihaps expected, that time will pioduce a 
similar effect in the subjects of the two last cases 


[ 312 ] 



1818 

JOHN CHEYNE 

DESCRIPTION OF THAT PERIODIC TYPE OF 
RESPIRATION LATER TO BECOME KNOWN 
AS THE CHEYNE-STOKES TYPE 




JOHN CHEYNE 

(1777-1836) 

^OHN CHEYNE was born on February 3, 1777, at Leith, the seaport of Edm- 
burgh His father was a physician and, according to Pettigrew, was a man 
of great cheerfulness, benevolence, good sense, and singleness of mind Cheyne’s 
mother was the daughter of William Edmonston, a fellow of the Koyal College of 
Surgeons (Edmburgh) 

Young Cheyne’s education began with four years at the grammar school at Leith 
When he was ten years of age he was sent to the high school at Edinburgh There 
he was placed under the care of Dr Adam, rector and headmaster This seems to 
have been an ill-advised step, for Cheyne was not yet ready for high school and was 
couseoLuently unable to keep up with the required pace In general, he was very 
unhappy while he was at school 

Soon he left high school and was tutored by a clergyman of the Episcopal Church 
of Scotland Under his new instructor he studied Greek and Latin for a period 
of two years, but again, as at high school, he apparently profited little from this 
contact 

When he was twelve years old he made his acquaintance with the practice of 
medicme by assisting his father m carmg for the elder Cheyne 's charity patients 
It was his duty to supply these patients with medicme, to bleed them when neces- 
sary, to dress their wounds, and to report their conditions to his father 

In 1792, Cheyne began to attend the medical lectures at the University of Edin- 
burgh His contacts with his father’s patients, effects of medical lectures he had 
heard, the boarding-house jargon of medical students, his frequenting a club of 
students who alternately examined each other in the required medical subjects, 
and the assistance of the celebrated “grinder,” Mr Caudlish, all combined to aid 
Cheyne when he took his examination in 1795 This he passed without difficulty, and 
obtamed his medical degree 

Following graduation, Cheyne left Edinburgh for Woolnch, where the Eoyal 
Eegnnent of Artillery was quartered There he was appointed to the medical corps 
as assistant surgeon He served with the army in various parts of England until 
1797, in which year he was elevated to the rank of surgeon He accompanied a 
bngade of home artillery to Ireland, and was in action in the campaign against the 
rebels at Eoss and Vinegar Hill in 1798 

Ohejme left the army in 1799 and returned to Scotland On his return he was 
placed in charge of the Ordnance Hospital at Leith Fort He also assisted his 
father in medical practice At this time he was fortunate in making the acquaintance 
of Charles Bell (1774-1842), the leading British physiologist of the day, who later 
was kmghted for his researches in the field of neurology Bell assisted Cheyne in 
making dissections and taught him the rudiments of pathologic anatomy 

Chejme had in 1795 published his first work, “De rachitide,” which no doubt was 
his doctorate thesis He continued his studies of pediatrics and between 1801 and 
1819 published several essays on the diseases of children 

In 1809 Cheyne left Scotland and after visiting Dublm, decided to practice medi- 
cine there His first two years in Dublin were rather unproductive so far as patients 

[315] 



were concerned But in 1811 he was appointed physician to the Meath Hospital, 
and the appointment seemed to he the turning point in his career He soon was 
called on to lecture on military medicine at the Irish College of Surgeons, and his 
private practice began to increase In 1815 he was appointed one of the physicians 
to the House of Industry 

The Dublin hospital reports for 1818 contain Cheyne’s classic paper, “A Case of 
Apoplexy, in which the fleshy part of the Heart was converted mto fat ” In his his 
tone account, which we are reprinting, Cheyne mentioned the unusual type of breath- 
ing now known as the “Cheyne-Stokes respiration” Stokes, as we shall show, 
put more emphasis on the diagnostic value of this symptom, but Cheyne was the 
first accurately to describe it 

In 1820 Cheyne was appointed physician-general to the Army m Ireland This 
was the highest medical rank in Ireland With this rank and with a highly suc- 
cessful medical practice, he felt he had fully attained the object of his ambition 

Chejme’s health had never been robust and his medical practice fatigued him to 
such an extent that he soon found it necessary to limit its scope He gradually de 
dined the responsibilities of private practice and limited his work to that of a con 
sultant In 1825, at the age of forty-nine, he was afflicted with a type of “nervous 
fever ’ ’ This deprived him of much of his remaming strength and he sought relief 
by spending a few months m England He later returned to Dublin, where he con- 
tinued some professional activity until 1831 Then he decided to retire He moved 
to a country town, Sherrington, in England He did not give up his mterest in medi- 
cine, but gladly undertook to contribute articles for the “Cyclopaedia of Practical 
Medicine ”i 

In 1833 a cataract formed in his right eye, depnving him of the sight of that 
organ, and in 1835 gangrene developed in one of his limbs He died on January 31, 
1836 


and Piper, 1833, 4th vol 


[ 316 ] 



A CASE OF APOPLEXY, IN WHICH THE FLESHY PART 
OF THE HEART WAS CONVERTED INTO FAT=" 


By 


J. CHEYNE 

D oubts having been entei tamed of the convex sion of the fleshy part 
of the heait into fat, and only one dissection,! in so far as I know, 
having been published illnstiative of that veiy ciuions nioibid alteiation, 
the following case and dissection have been thought of sufficient impor- 
tance to meet the public eye 

In this dissection, although no chemical expeiiment was made in proof 
of the mattei into which the heait was converted being fatty, I have no 
doubt that it was so Placed along side of the fat which lay over the 
ribs, I could peiceive no diffeience, save that it was softer and moie 
easily tom, and lathei of a deeper yellow, the substance in question 
communicated a greasy stain to paper, and the animal oil in viscous drops 
adhered to the knife used in dissecting the heart I was not, at the time 
of dissection, awaie that the morbid change was so uncommon, or that 
the specimen which lay before me was perhaps the most complete ex- 
emplification ever witnessed of the conveision of the flesh of the heart 
into fat 

The patient ceitainly died of apoplexy, and apoplexy m this case must 
have depended upon increased action of the vessels of the head The 
heart itself was apparently incapable of communicating much impetus 
to the circulating mass 

Ceitainly the dissection would liaA^e been more complete had the liver 
been examined at the same time I may observe, that although the func- 
tion of the liver had frequently been disoideied during the last ten years 
of the patient’s life, I should not have been surprised had that viseus 
been found apparently sound I am persuaded that diseases of the livei, 
which do not end in structural changes, often produce the greatest dis- 
turbance of the constitution, laying the foundation of fatal diseases of 
distant organs 

A B , sixty years of age, of a sanguine temper ament, circular chest, 
and full habit of body, for years had lived a veiy sedentary life, while he 
indulged habitually in the luxuries of the table 


•Published m Dublin Hospital Reports 2 216-223, ISIS We reprint from Medical 

Clis-^icsS TOi-VOO 1039 — r A W 1940 

.. tSee a dissection illustrathc of this morbid change m an elaborate paper on InHamma- 
tlon of the heart b^ Dr Duncan jun See Edin Med and Surgical Journal Jan 1816 


[ 317 ] 



This gentleman liaAnng had several attacks of the gout m his feet 
began a couise of magnesia in the yeai 1813, after which he had only one 
regular attack of the gout For many years he had been subject to severe 
attacks of catarrh, which ended without much expectoration He had 
long been subject to oedema of the ankles m the evening, for two or 
three yeais before his death (the time eould not be ascertained) he had 
lemaiked an occasional intermission in the pulse of his heart 
In the latter end of January 1816, he consulted me for a pain in his 
light side under the false ribs, for which he took calomel at bedtime, and 
salts in the morning, repeating these once or twice, but he neglected my 
directions with regard to diet, naj^, his appetite being remarkably keen, 
he ate more than usual, and took at least a pint of port wine or Madeira 
daily, as was his habit, and this notwithstanding a hard frequent cough, 
which came on after I was consulted by him 

On the thud of Febiuaiy he had walked a good many miles and came 
home exhausted, with a fluttering or iialpitation of his heart, for he 
could not well saj'’ which, in a degree he had not felt before Tie ate as 
usual, and drank six or seven glasses of wine, which he thought relieved 
the fluttering He was sitting at tea about nine o’clock when he was at- 
tacked with a severe fit of coughing, duiiiig which he fell from his chair 
insensible 1 saw him in thiee oi four minutes after his fall, and found 
him with a contusion on the upper and left side of the frontal bone, he 
was confused, and unable to leeollect himself, he was conscious that 
some accident had befallen him, the exact nature of which he declared 
himself incapable of understanding IIis pulse was extremely irregular 
and unequal It bounded quickly for sevei al pulsations, then it paused 
and went on moie quickly, but with less force He was pale, but none of 
the muscles were affected with palsy I lost no time in having blood 
drawn from his aim to the amount of nearly a pound He gradually 
became more collected, but his pulse continued ii regular and unequal, 
his countenance became flushed, the cough occuiied in suffocative fits, 
and he complained of pain on either side of the tuberosity of the occipital 
bone Twelve ounces more of blood were diawn about an hour after the 
first blood-letting, after which the pulse, though it continued equally 
irregular, was much softer He complained of the contusion, and of con- 
siderable pain behind his eais He was removed to bed, the heat of the 
extremities was restored, and fifteen leeches were applied over the con- 
tusion, and he took two pills consisting of two giains of James’s powder, 
three of calomel and four of compound extract of colocynth 

On the 4th of February he had several large bilious stools, his under- 
standing was unimpaired, his recollection restored, and he seemed to 
comprehend the nature of his illness, and he had a sense of fulness in his 
head, which led me to order him to lose a few more ounces of blood It 


[318 1 



would be tedious and unpiofitable to paiticularize the medicines which 
were oidered from day to day foi this patient, they consisted of a mild 
mercurial every second or third day, and squills with ammoniacum, etc 
These were indicated by the loaded tongue, scanty high colouied urine 
and dry cough The expectoration being lestoied, the squills were laid 
aside on the 15th of February, as they produced nausea and extreme de- 
pression of spirits, and bitter infusion with tincture of cardamoms and 
soda was prescribed On the 19th a horse-radish bath was ordered, in 
consequence of some slight demonstration of gout On the 21st he had 
some smart pain, with slight inflammation in the ball of the left gieat 
toe About this period he submitted with so much dissatisfaction to a 
reduced diet, and declared himself so much better after food, that we 
were induced to allow him a eoujile of glasses of wine, and to encourage 
him to take carnage exercise The iriegulaiity nr his pulse never ceased 
On the 1st of March he had a return of the sulfocative cough and flush- 
ing, with some wheezing, which again seemed to demand blood-letting, 
which was practised with immediate relief At this peiiod a blister was 
applied over the region of the heait, which had become the seat of con- 
siderable increase of pain, and a dischaige was maintained fiom the 
blistered surface, by means of ointment of savine and canthaiides, about 
the 4th of March, the sputa became free and concocted His tongue at 
this period was for many days furred and of a dark brown colour, as if 
it had been sprinkled with ground coffee, it was expanded, and its edge 
was moist On the 25th of March he began to complain of wheezing, 
more paitierilaily after exertion, but it sometimes attacked him when 
he was at peifect rest, his legs and ankles became oedematous, the uiine 
veiy scanty, much loaded, but without being eoagulable by heat At no 
period of his illness did his pulse beat more than twelve, or fifteen strokes 
nr regular succession Various diuretics were given, the digitalis was 
proposed, but he refused to take it Crystals of tartar, the extraetum 
lactucae virosae, nitrous aether etc, were tried without any benefit 
The symptoms of dropsy rapidly nrci easing, on the 9th of April, he 
took a draught of infusion of senna, tinctiiie of jalap and Rochelle salts, 
which operated largely On the 10th of April he was found in bed flushed, 
speechless, and hemiplegiac How long he had been in that state could 
not be ascei tamed, as he had peiemptoifly ordered his seivant not to 
lemain in the chaiiibei with him, and not to come to him nr the morning 
till called All attempts to relieve him were unavailing, his right side 
continued pow'eiless, and his attempts to articulate rveie vain The only 
peculiarity in the last period of his illness, which lasted eight or nine 
days was in the state of the lespiiation For several days his breathing 
was iiiegiilai, it would entirely cease for a quarter of a minute, then 
It would become perceptible though very low, then In degrees it be- 
came IioaMiig and quick, and then it would gradually cease again this 

[ 319 ] 



revolution in the state of his breathing occupied about a minute, during 
which there weie about thiity acts of lespiiation 

The Dissection was made by Mr Ciampton, the Surgeon General, and 
witnessed by Mi John Moor and myself 
There was nothing remarkable in the configuiation of the body but 
the great depth of the chest , the anasarcous swelling of the inferior ex- 
tremities was eonsideiable 

The scalp was bloodless The aiachnoid membiane was slightly 
opaque, theie was some fluid between it and the pia matei, and the vascu- 
larity of the lattei was increased, moie particulaily ovei the middle and 
posteiioi lobes of the eerebium on the left side, wheie, in a laige patch, it 
was thickened and of a deep led coloui The hi am was firm, its coitical 
substance of a pale diab eoloui Theie weie between thiee and foui 
ounces of fluid in the ventiicles 

There weie not moie than two ounces of fluid m the peiicaidium The 
heart was about thiee times its natuial swe The lower pait of the right 
ventricle was conveited into a soft fatty substance, the uppei part was 
remaikably thin, and it giadually degeneiated into this soft fatty sub- 
stance The cavity of the left ventricle was greatly enlarged The whole 
substance of the left ventiicle, with the exception of the internal reticu- 
lated structure and caineae eolumnae, was conveited into fat The 
valves were sound The aorta was studded with steatomatous and earthy 
concretions 


I am Ignorint of, not having been permitted to examine the body after death 


[ 320 ] 



1819 

RENE THfoPHILE HYACINTHE LAENNEC 

THE INTRODUCTION OF THE STETHOSCOPE 
AND AUSCULTATION 




EENfi THeOPHILE HYACINTHS LAfiNNEC 


(Courtesy Annals of Medical History ) 



RENE THEOPHILE HYACINTHE LAENNEC 

( 1781 - 1826 ) 

“I -profess free medicine, I am not loitli the ancient noi with the modem, hit seeh 
the truth in each, and test everything by i epeated trial ’ ’ 

— ^Laennec’s ciedo from lus doctoral tliesis, after Webb 

Auenbrugger, long past his prime, was leading a retired life in Vienna, 
\ScJ 21 child of sickly appearance was horn of a probably tuberculous mother at 
Quimper in Lower Brittany, one of the most beautiful districts m France His name 
was Rene Theophile Hyacmthe Laennec 

The other immediate members of the family were a boy, Michel, who was born 
in 1782, and a girl, Marie, born in 1785 Another girl was born in 1786, but she lived 
only a few days and the death of the brave mother of this family occurred shortly 
afterward The father was a lawyer and to judge by subsetiuent records, was not a 
very successful one He also wrote poetry and that not too well 

After the death of the mother, the father, seemmgly unable to accept the re- 
sponsibilities of rearing his sons, sent the two boys to live with their paternal uncle, 
Michel, the rector of a parish in Elliant This clergyman shortly afterward became 
one of the 6migr6s to England And so in 1788, after spending about a year with 
Uncle Michel, the boys were sent to their other and more famous uncle, Guillaume- 
Frangois Laennec, a former pupil of John Hunter and professor of medicine at the 
University of Nantes Dr Guillaume Laennec was interested in many things besides 
medicine He enjoyed the humanities, was proficient in the Greek classics, derived 
pleasure from writing and was an effective speaker Rend profited much from this 
association and indeed his physician uncle was more than a father to him 

For three years the two boys studied at L’lnstitution Tardivel, and in 1791, 
Rend was placed in the College d’Oratone There he studied religion, political 
science, orthography, grammar, geography, Latin prose and verse 

Contrasted to the peaceful life Rend was leading as an individual was the tur- 
moil m which his country was embroiled For by this time the French Revolution 
was in full sway The new powers, Mirabeau, Danton, Robespierre, Marat and 
Carnot, were reshaping the destinies of millions Even the son of sixty kings, now 
Citizen Louis Capet, was on his way to the guillotine Rend, himself, must have 
felt the horror of this bloody revolution for he had seen several heads drop from 
the guillotine which was stationed m the square outside of his home in Nantes His 
uncle was imprisoned for six weeks on suspicion of bemg out of sympathy with the 
contemporary government 

Despite the political confusion and chaos caused by the Revolution, the educa- 
tion of Laennec was not neglected In 1793 he entered the National Institute In 
1795, encouraged by his uncle, Laennec began the study of medicine at the early 
age of fourteen and a half years L’Hotel Dieu at Nantes, where he began his 
study, was a large hospital, contammg 400 beds His uncle had charge of 100 beds, 
most of these were occupied by sailors suffering from tropical diseases Besides 
medicine, Laennec studied botany and he also found time for the studj’’ of Greek at 
L’ficole Centrale 


[ ] 




THeOPHILB LAfilSTNEC OlSr HIS BOUNDS IN THE NECKEB 
HOSPITAL IN PAEIS 

Prom a painting 'by Chartrau 


(Courtesy Eoche Eeview ) 



After spending five years at Nantes, Laennec, at the insistence of his uncle, was 
sent hy his father to Pans There he immediately enrolled at L’^cole de Mddecme, 
which at that time was championed hy the great Jean Nicolas de Corvisart Corvi- 
sart was the founder of French clinical medicine, and when Napoleon hy chance 
became Corvisart ’s patient, the Emperor singled him out to he his personal physician 
It was Corvisart, also, as we have shown, who caused Auenhrugger’s discovery of 
percussion to he broadcast throughout the medical world From all accounts, 
Laennec got along well with his famous teacher and received much genume en- 
couragement from the master on the theories that he advanced It is interesting to 
note in this connection that at some time later, the aphorisms of Corvisart were 
published hy Laennec, who had collected and preserved them during his residency 
in Pans 

Other famous teachers of Laennec were Mane Frangois Xavier Bichat (1771-1802), 
whose work in physiology and medicme resulted in the founding of pathologic 
anatomy and scientific histology, and Eaion Guillaume Dupujrtren (1778-1835), whom 
Garnson descnhed as “the ablest and best trained French surgeon of his time'’i 
Dupuytren tolerated no rivals and consequently he and Laennec did not get along 
In 1802 Laeimec observed, during necropsy on the body of a patient who had 
had cardiac disease, ossification of the mitral valves and dilatation of the ventricle 
His report of the case constituted his first published work Laennec ’s lecture in 
March, 1804, on tuberculosis, delivered shortly before his graduation, established 
the fact that phthisis was simply tuberculosis of the lungs From that time on- 
ward the disease was called “pulmonary tuberculosis ’’ 

Laennec received his doctor’s degree in June, 1804 His thesis was entitled 
“Propositions on the doctnnes of Hippocrates in regard to the practice of medi- 
cine ’ ’ 

For five years after graduation Laennec busied himself lecturmg on pathologic 
anatomy, domg what private practice he could, and contributing several articles to 
medical journals, and to the medical dictionaries and encyclopedias which were then 
in fashion Many of his articles were published in the “Journal de Medecine” of 
which he was an editor from 1805 to 1808 It is apparent from some of his notes 
and editonals published therein that he was violently opposed to the nebulous 
theories of John Brown (1735-1788) and Frangois J V Broussais (1772-1838) 
Brown’s therapeutic ideas, according to Baas ,2 destroyed more people than did the 
French Revolution and the Napoleonic wars combmed Broussais thought that life 
depended on irritation and that disease owed its existence to localized irritation 
of the affected part Broussais felt that nature had no healing power and therefore 
his therapy consisted of starving the patient and applying leeches over various 
parts of the body Broussaism was such a popular doctrine that seven years after 
Laennec’s death (1833) 41,500,000 leeches were imported into France to be used 
for the purposes of bleeding 

In 1812 Laennec was appointed physician to the Beaujon Hospital During this 
time he especially interested himself in diseases of the chest and, of course, he em- 
ployed percussion in his diagnosis as he had learned it from his master, Corvisart 

Laennec became associated with the Necker Hospital in 1816 It was at this 
tune, also, that he developed the art of auscultation The story of his discovery is 
admirably told in his own words in the introduction to the second part (diagnosis) 
of his famous book, “De I’auscultation mediate ’’ 


M 


’Garrison F H In inttoduetton to the Iltstotii of Urdieuif' 
1> Compinv in^'i p 

*Qnot«,il In Gmifcon 31"> 


Ed i Philadolpliia 





“In 1816, I was consulted toy a young woman laTjounng under general symptoms 
of diseased heart, and in whose case percussion and the application of the hand were 
of little avail on account of the great degree of fatness The other method just 
mentioned heing rendered inadmissible by the age and sex of the patient, I hap 
pened to recollect a simple and well-known fact in acoustics, and fancied at the 
same time, that it might be turned to some use on the present occasion The fact 
I allude to is the augmented impression of sound when conveyed through certain 
solid bodies, as when we hear the scratch of a pin at one end of a piece of wood, 
on applying our ear to the other Immediately, on this suggestion, I rolled a quire 
of paper into a sort of cylinder and applied one end of it to the region of the heart 
and the other to my ear, and was not a little surprised and pleased, to find that I 
could thereby perceive the action of the heart in a manner much more clear and 
distinct than I had ever been able to do by the immediate application of the ear 
From this moment I imagined that the circumstance might furnish means for en- 
abling us to ascertain the character, not only of the action of the heart, but of every 
species of sound produced by the motion of all the thoracic viscera ’ ’ 

With the stethoscope Rend Laennec first heard the language of pathology Lesions 
within the thorax that for centuries had been inaudible now announced their pres 
ance At first, Laennec ’s discovery was treated with mdifiference by his immediate 
colleagues But although even his book met with a cold reception from these men, 
the first edition of 3500 copies was soon exhausted, and his deserved fame as a 
clinician and his pathologic work placed him on a firm footmg His foreign col- 
leagues greeted his discovery with much enthusiasm and soon physicians from all 
over Europe crowded into the Necker Hospital to hear his ideas on auscultation At 
last his own colleagues were convinced of the validity of Laennec’s discovery 
Laennec was made professor of medicine in the Collfege de France in 1822 and si- 
multaneously became a member of the Academy of Medicine of France A year 
later he succeeded his teacher, Corvisart, in the College He also at that time was 
appointed physician to the Duchess of Berry In 1824 Laennec was made a knight 
of the Legion of Honor 

That same year Laennec married a widow, Madame Argou It was a mamage of 
convenience, not of love The widow, who had been his housekeeper, was about 
forty-five years of age and ill health made her look older Laennec, himself, pre 
sented an emaciated appearance, suffering as he was from asthma 

In 1826 Laennec published the second edition of his work on mediate ausculta- 
tion This entailed considerable hard work and his health, which had never been 
robust, broke down In April of 1826, he contracted a severe cold This was ac- 
companied by infection of the throat, high fever, and thoracic pains From that 
time onward his health became progressively worse He died on August 13, 1826 

Except for his treatise on auscultation (1819), Laennec’s most important contribu- 
tions to medicine were produced during the begmning of his career They included 
his description of the pathologic appearance of peritonitis (1803) and a description 
of the capsule of connective tissue investing the liver (1803) In 1806 Laennec 
published the first accurate account of melanosis, and in 1812 he described an ex- 
traperitoneal type of hernia He was also the first to describe chronic diffuse inter- 
stitial hepatitis 

The “Boston Medical and Surgical Journal’’ recorded m 1867 that 20,000 francs 
had been raised during that year for a monument to Laennec, the money havmg 
been raised chiefly in France, but in part by the Medico-Chirurgical Society of 
London and also by physicians in Scotland, Ireland, Prussia and Austria Modelled 
by Lequesne and cast by Ducel, the monument was exhibited at the Pans Exposition 
and was dedicated in May of 1868 


[ 326 ] 



A 


TREATISE 

ON THE 

DISEASES OF THE CHEST. 

IN WHICH THEY ABE DESCRIBED 
ACCORDING TO THEIR 

ANATOMICAL CHARACTERS. 

AND THEIR 

ESTABLISHED ON A NEW PRINCIPLE 
BY MEANS OF 

ACOUSTICK INSTRUMENTS. 

IDitb 

TRANSLATED FROM THE FRENCH OF 

R T. H. LAENNEC, M D 

WITH 

A PREFACE AND NOTFS, 

BY JOHN FORBES, M D. 

tHTSICTAN TO THE PLVZAKCI IlISPtNSAHT, SECHETAHY OF THE HOYAL 
OEOJ.OOICAL SOCIETY OF COHNWAiL, &C 5cC 

FIRST aJiCERlCJlJ^ EDITION 

PHILADELPHIA . 

JAMES WEBSTER, 24 S EIGHTH STREET 

R tlltam JJrrKTT, Prirler 

1823 



TREATISE ON MEDIATE AUSCULTATION^ 


PREFACE 


I BEGAN, thiee years since, the leseaiehes of which I now pubhsli 
the results Although these have not i cached the degiee of peifee- 
tion which longer expeiienee would have confeired on them, I have 
thought it advisable foi many leasons, to communicate them to the 
public Among those leasons I may mention — ^the incoiiect accounts 
of my diseoveiies that have found then way into the journals of the 
day, the favouiable leport of the Academy of Sciences, f and the hope 
and conviction that the mode of exjiloiation detailed in this work will be 
coiifiimed and extended by othei obseiveis 
It will be found that of the facts naiiated m my tieatise, I have given 
some as ceitain, othei s as doubtful, and a few mei ely as pioblematieal 
Of the fiist class, if futuie expeiienee should invalidate any, I may ven- 
ture to believe that the numbei will be few, and I am even convinced 
that the gieatei pait of those which I have stated as doubtful, will be 
found bj’- fuilhei obseivation to be constant and ceitain 
In respect of the pathological details, which constitute so laige a poi- 
tioii of the work, I think it necessaiy to make a few observations The 
gieat attention that has been paid to morbid anatomy, since the com- 
mencement of the piesent century, throughout Euiope, and moie es 
pecially in Pans, has been pioductive of many impiovements and dis- 
coveiies which aie but impeifectly known, and, indeed, many of which 
have not at all been communicated to the public, at least by their dis- 
coveiers On this account, the piesent state of oiu wiitten knowledge is 
obviously behind oiii actual Imowledge, and if, in the piesent woik, I 
had contented myself with meiely desciibing the signs of the oiganie 
lesions, without desciibing the lesions themselves, I should have often 


■"Laennec R T H Tiaiti dc Vauscultation mediate The first French edition was pub- 
lished in 1819 We are repiinting from the flist American edition, published in 1823 — F 
A W, 1940 

tExtract fiom the Report of the Academy of Sciences (draiin up bj M Perm and 
signed by him and MM Poital and Pelletaii 2<)tli June ISIS) on i Memoir of M 
Laennec respecting the use of Auscultation, more pai ticularly m Phthisis Pulmonalis 

“The Cj Under applied to tJie chest of a healtlij pel son who sings or speaks produces 
a sort of vibration winch is more distinct in some places than others But when theie 
exists an ulcer in the lungs the patient’s \oice then instead of being heard m the usual 
manner by the exposed ear reaches tlie other cntiiely through the tube of the mstiument 
We have ourselves verified this fact on several consumptne patients, it appeared to us 
striking, and well fitted for furnishing a certain and easy sign of certain morbid con- 
ditions of the lung, which, in the present state of medicine can only be suspected to 


exist 

• We have also examined by means of the cj hnders the i espiration m different parts 
of the chest of a healthy person and found it veij distinctly audible in every point of 
this cavity which corresponded with the lungs We have also found that the motions 
of the heart were equally perceptible, and it has consequently, appealed to us that the 
assertions of the author of the possibility of obtaining through these two kinds oi 
auscultation, certain signs of the several diseases of the heart and lungs, were at least, 
extremely probable " 

[ 328 ] 



run the risk of being not undeistood at all, oi (what is woise) of being 
misunderstood I have, theiefoie, felt that the only means left of es- 
caping tins dangei, ivas to give an anatomical desciiption of all the dis- 
eases of which I have noticed the symptoms In fulfilling this task I 
have endeavoured to render my descrij)tions concise, yet, at the same 
time, sufficiently exact and complete to characterise the ob;)ects 
Another motive has contributed to stiengthen this lesolution — ^viz 
the conviction of the practical utility of my mode of diagnosis, and the 
belief that the surest way of piocurmg its more general adoption was 
to associate the exposition of its pimciples with a description of the 
diseases which it indicates, more exact than any that yet exists 
Many reasons have induced me to prefer the anatomical to the more 
symptomatical description of diseases The formei method has the ad- 
vantage of brevity, perspicuity and certainty It is, foi example, much 
easier to describe tubercles and detail the signs of these, than to define 
the disease by the external symptoms only, and to ai range its varieties 
according to then causes Emph3'’sema of the lungs consists in an altera- 
tion of parts which can be described in a few words, and of which the signs 
can be easily leeognised, while in studjnng asthma, according to the method 
of Sauvages, we shall require to wiite a volume on generalities before 
we can airive at anything positive 

It will, perhaps, be objected that the anatomical method has the dis- 
advantage of founding its species on distinctions, the chief characters 
of which can only be obtained aftei death but this objection scarcely 
nieiits refutation We might as well say that it is useless for surgeons 
to make any distinction between dislocation of the femiii, and fracture 
of its neck, oi that it is useless to separate bionchitis from peripneu- 
niony 

The nioibid alteration in the affected organ is, unquestionably, the 
least vaiiable and most positive of the phenomena of local disease, it is 
on the nature and extent of this alteiation that the dangei and curability 
of diseases alwajj-s depend , and it is this, consequentlj'-, that ought to be 
eonsideied as chaiacteiising them On the contiaij’’, the derangement of 
functions which accomiianies these alterations is extiemely variable 
it IS often the same under ciicunistaiiees entiielj^ diffeient, consequentlj’', 
it can rarely sene to discriminate different diseases 
Besides, it is a mistake to consider the recognition of nosological 
species, founded on the data of morbid anatomj’-, as mipiaeticable be- 
foie death on the coiitiaijq thej’- are often moie readily lecognised 
dining life, and certainly present to the mind something much cleaiei 
and more positue, than anj' nosological distinction founded on the sjunp- 
toms nieielv Peritonitis, foi example, is assuiedh* a disease easily dis- 
tinguished during life, and out of twenty medical men acquainted witli 
moibid anatomy called to see a case of it not one will make a mistake 

132 &] 




PLATE VIII 

Fig 1 The Stethoscope or Cjlmdei, i educed to one third its nctual dimensions 
a Stoppei 1) The lou er end c The uppei half d The auriculai oi upper evtremitj 

Fig 2 Longitudinal section of the same a The stopper b Point of union of 
the two parts c The upper half 

Fig 3 The same section, with the stopper removed 

Fig 4 The stoppei a The body of it, formed of the same uood as the rest of 
the instrument b Small brass tube traversing the stopper, for fixing it in the tube of 
the stethoscope 

Fig 5 Upper half of the stethoscope a Body of it b Screw (in the wood) for 
fixing the two portions together 

Fig 6 Actual diameter of the stethoscope 

NB Any turner will be able to make the instrument, from the abo\e description 
— Trans 


[ 330 ] 




concerning its nature oi name But will this be the case with those who 
are accustomed to see m diseases nothing but sjnnptoiiis^ Of the twenty 
shall we not find one considering the affection as %leus, another as hepatic 
colic, a third as puei petal fevei, and so on^ The same thing may be said 
of peripneuniony, nephritis, hepatitis etc , and I hope that the woik 
now submitted to the public will enable us to say the same thing of 
most of the diseases of the lungs, pleuia and heait 
Morbid anatomy must, then, I think, be eonsideied as the suiest 
guide of the physician, as well to the diagnosis as to the cure of dis- 
eases But it must not be foi gotten that it has also its obseuie points 
It IS, no doubt, an easy matter to distinguish striking changes of stiuc- 
tuie, but theie aie many slightei alteiations, among which it is difficult 
to ascertain what is healthy and what diseased, what cause and what 
effect, and, lastly, whethei the appearances are truly the effect of dis- 
ease, 01 meiely an accident of assimilation, or circulation, that has 
taken place in aiticulo moitis, oi even after death In these cases we 
must content oui selves with what is clear and distinct, never foi getting 
in practice the principle of Hoffman — Niinquam aliquid magm facias ev 
met a conjectwa ant hypothesi, and sedulously guaidmg against the 
erioi of believing that the mere knowledge of the seat and natuie of 
the disease can justify oui neglecting its individual chaiactei, as in- 
fluenced by external cii cumstances oi peisonal idiosynciasy 
From the foregoing observations it will be seen that this woik is not, 
like that of Auenbiugger, a simple exposition of new means of diagnosis 
Neithei can it be eonsideied as a monogiaphy of the diseases of the 
chest, — since I have taken little notice of the ordinary and more geneial 
symptoms of the diseases, and have not at all touched upon their treat- 
ment 


In the construction of my treatise I have quoted but two authors 
The chief object of my researches was, in a great measuie, new, and 
for tlie facts already known respecting the diseases of the lungs and 
heait, I ha\e thought it unnecessary to go beyond the woiks of M Corvi- 
sait and Bayle If I have occasionally differed fiom these distinguished 
authors, I trust no one will misniteipiet my motives No one can be 
nioie sensible of then nieiits, both as men and Physicians, than mj^'self 
At the veiy time I question then opinions, I most willingly confess my 
gieat obligations to them It is much casiei to impiove a field alieady 
ciiltnated, than to reclaim a mid and baiien soil In lespect of the 
voiksofM CoiMsait moie paiticulaiiy it is to be legietted that those 
of them published by others aie fai fiom giMiig a just idea of the 


cocur, etc pn J X Com^nrt 


"iiir If "t matadia ct tes h ')wns oioaniQucs dtt 
Trin^Htt il b^ Hcbb Lontlon bixlciwood 

XotneUe Mu thadc pour rccontiotitc Jes mnladtct intctnc'! dc ta poiirxnr par la vrrcussion 

comnfent/ J X 

V^amonatre par C UBa^lo 3S10 Tran-l 

[ Sll ] 



authoi ’s merits The nnceitainty of the signs of diseases, and the vague- 
ness of desciiption in these, appeals peculiaily sti iking to those who, like 
myself, weie his pupils, and habitual witnesses of the boldness and pre- 
cision of his diagnostics This defect, no doubt, paitly depends on the 
incommunicable tact of the physician, which foims so gieat a pait of 
the art, and which M Coivisait possessed in the highest degiee 
I have holies that the advantages of my method of diagnosis may be 
extended, in some degiee, to veteiinaiy medicine Many leasons, how- 
ever, exist, why this ait must deiive infeiior benefit fiom it Among 
these I may mention the absence of the voice, — the couipaiative inacces- 
sibility of the legion of the lieait, and, lastly, the gieat indistinctness 
of lespiiation in the hoise, and piobably all heibivoious animals In 
eases of disease, howevei, tlie lespiiatioii will be nioie audible in the 
sound 2301 lions of the lungs, as I found in a case of iieiipneumony in a 
cow, which I lecognised dining the animars life, as easily as in the 
human subject In the dog, and cat, and piobably in all cainivoioiis 
animals, the sound of lespnation is as distinct as in man Notwithstand- 
ing these difficulties, I have no doubt tliat fiiithei exiieiience will piove 
the utility of mediate auscultation in llie disease of animals, especially, 
if combined with peicussion of the chest 


OF THE ACTION OF THE HEART IN QENERAL, IN 
HEALTH AND DlSEASEf 

Befoie enteiing upon the diagnostic signs fuinislied by the stethoscope 
in paiticulai diseases of the heait, it will be necessaij’’ to examme the gen- 
eial lesults affoided by it, as well in the sound as diseased state of that 
organ I shall do this undei foui piineipal heads, viz 1st, the extent of 
the healths action, as ascei lamed by the cylmdei , 2nd, the shock or im- 
pulse communicated, 3id, the natuie and intensity of the sound, and 4th, 
the lytlim of its actions 


I Of the Extent of the Pulsation of the Heait 


This must be consideied in two points of view — first, the sensation con- 
veyed by the mstiument when applied to the legion of the heait, and, 
secondly, the parts of the chest (other than this legion) in which its action 
can be perceived 


*The author further suggests the pi obable utility of the stethoscope m the instruction 
of the deaf and dumb by applying one end of it to the tischea of the speaker 
the other to the ear of the pupil —but surely this must be fanciful— or at least of m 
ferior value to other means — Trans 

fLaennecs work m the tianslation by John Forbes is composed 
First, Book Second and Book Third We have reprinted portions of Book Thiid wmcn 
deals first, with diseases of the heart and serand vith diagnosis of ° 

heart Excerpts from these two parts of Book Third are not reprinted tug 

in which they appear in Forbes' tianslation To aid b'® . 

two Darts of Book Third a star has been appended to the titles of all pimgiaphs I , , 

from the first part of Book Third (on diseases of the heart) P®rapaphs «of ma^ 
with a star have been taken from the second part of Book Third (on diagnosis of d s 
of the heart) — F A W , 1940 


[ 332 ] 



1 In the natural condition of tlie organ, the heait, examined between the 
caitilages of the fifth and sixth iibs, and at the lowei end of the sternum, 
communicates, by its motions, a sensation as if it corresponded evidently 
with a small point of the thoiacic paiietes, not laigei than that occupied 
by the end of the stethoscope Sometimes, it appeals as if it were placed 
deep in the mediastinal cavity, leaving a vacant space between it and the 
sternum in this case its movements, even when pietty eneigetic, appear 
to communicate no vibratoiy impulse to the neighbouiing parts In othei 
cases, again, the heart seems entirelj^ to fill the cavity of the mediastininn, 
and to extend much beyond the point on which the instiument rests, and, 
in this case, its conti actions, even when slow and noiseless, seem to elevate, 
to a consi del able extent, the thoracic paiietes before them, and to displace 
the adjacent visceia within This differ eiice of sensation seems, m a word, 
to convey the impression of the action of a smaller or a larger heart, and, 
geneially speaking, this indicatioii is sufficiently correct, when the organ 
IS examined in the state of quietude which results simply from repose of 
bodj'- 

2 The second point is of more practical importance In a healthy per- 
sou, of moderate fulness, and whose heart is well proportioned, the pulsa- 
tion of this organ is only perceived nr the cardiac region, that is, in the 
space comprised between the cartilages of the fifth and seventh ribs, and 
under the lower end of the sternum The motions of the left cavities of 
the heart aie chiefly perceptible in the former position, those of the right 
cavities in the latter This is so much the case, that, in disease of one 
side of the heart only, the pulsation m these two situations gives quite 
different results 'When the sternum is short, the pulsations extend to the 
epigastrium In reiv fat subjects, the pulsation of wliose hearts is quite 
imperceptible to the mere toueli, the space nr which it can be detected by 
tlic cylinder is sometimes not more than an inch square In thin pel sons, 
in the liar row-chested, and, also, in children, the pulsation is more extended, 
being perceptible orer the lower thud, or even three-fourths, of the 
sternum, and sometimes eren over the uhole of this bone, also at the su- 
perior part of the left side, as high as the clavicle, and sometimes, though 
feebly, under the right clavicle 

Wlieii the pulsations are confined to the places above mentioned, in 
subjects of the kind noticed, and nhen they are mueli weaker belou the 
eluMcIes than in the region of the heart, ue mav conclude that this viseus 
IS veil piopoitioned 

When the pulsations of the heart become more extended, thev are heaid 
suceessnclv m the folloning places — 1st the vhole left side of the chest, 
liom the axilla to the stomach 2nd, the nhole of the light sides, 3id, the 
postenoi pait of the left side of chest and 4th the posfeiioi part of the 
iniht sido This last is inie In these cases the intensiU of (he sound is 
piogiessnelv less in the succession mentioned This succession has ap- 

OO i J 



peaied to be constant, and may be taken as an index of the extent of 
pulsation For instance, if this be peieeptible on the light side, we may 
be assured that it will be equally so over the whole sternum, under both 
clavicles, and ovei the left side, but Ave are not suie that it will be so on 
the back But if it be peieeptible on the back on the light side, Ave may 
calculate on its being still more audible in every othei part of the chest 

Several circumstances unconnected AVitli the state of the heart may de- 
lange the older above mentioned, and augment the extent of the pulsa- 
tion This lattei effect is pioduced by a hepatized oi compressed lung, 
and also by a pait containing tubeieulous excavations In every ease the 
heart gives tAAm distinct pulsations foi one beat of the aiteiial pulse In 
my examinations of seveial hundicd individuals, I have only met with 
one in Avhom the pulsation of the subclavian ai terms could be heaid by 
the stethoscope , and I may state it is an almost uniAmrsal fact, that neithei 
the pulsation of this aitcij', noi of the aoila, can be mistaken foi that of 
the lieait 

When the pulsation of the heai t is heai d OAmi a gi eatei extent than Avhat 
IS above stated to be the lange of a AAmll propoitioned oigan, the individual 
rarely enjoys good health If he has not foimal dyspnoea, he has, at least, 
shortei bieath than usual, is put moie easily out of bieatli, and is more 
subject to palpitation This state, hoAvcAmi, AA'hich is that of many asth- 
matics, may remain stationaij"- many yeais, and does not ahvays prevent 
the attainment of an advanced age 

With regal d to the i elation betAveen the state of the heait and the ex- 
tent of its pulsation, I think it may be taken as a geneial fact, that the 
extent of pulsation is in the diiect latio of the thinness and wealmess 
of the heait, and consequently, inveiselj’^ as its thickness and strength 
The size of the oigan must also be consideied as affecting the extent of its 
pulsation 

In explanation of Avhat has been just stated , Ave may presume, Avhen the 
pulsation extends ovei all the places above mentioned, that the heart is 
increased beyond the natural size, and that this inciease is oAving to the 
dilatation of one oi both ventiicles This presumption aauU be stiength- 
ened, if the pulsation is as gieat undei the clavicles oi in the axilla, as in 
the region of the heart If the pulsation is perceived neither in the back 
noi light side, but only in the other points mentioned, and if its intensity 
is nearly equal in all these, Ave may conclude that the ventricles are mod- 
el ately dilated, and that the paiietes of the heart are natuially thin On 
the central y, when theie is veiy stiong pulsation in the region of the 
heait, and none or veiy little under the clavicle, Ave may be assured (if 
the patient has other geneial symptoms of diseased heart) that the disease 
is hypertrophia of the ventiicles If the patient has never experienced 
any marked disoidei of the ciiculatoiy oigans, Ave may be certain that the 
paiietes of the left ventiicle aie much thickened, though still not sufficient 
to constitute disease 


[ 334 ] 



Geneially speaking, then, it may be taken, for granted that a great ex- 
tent of pulsation is a maik of thin paiietes of the heait, nioie paiticnlarly 
of the ventiieles, and that a confined lange of pulsation eoincides with 
an inci eased thickness of these Some accidental causes maj’' augment foi 
a time the extent of the heait ’s pulsation, such as neivous agitation, fever, 
palpitation, haemoptysis, and, in geneial, whatevei inci eases the fiequency 
of the pulse 

TI Of the Impulse Commumcatcd to the Ecu hy the Action of the Heait 

In investigating this we must be eaieful not to confound with the action 
of the heait, the use of the tlioiaeic paiieles duiing inspiiation This 
caution IS iiioie paitieuiaily necessaiy ■when the lespiiation is veiy shoit 
and frequent 

The degree of impulse communicated by the cylindei to the ear, is, in 
geneial, inveisely as the extent of the pulsation of the heart, and directlj^ 
as the thickness of the walls of the ventiieles In a peison whose oigans 
of eu dilation aie well jiropoitioned, this impulse is veij'’ little perceptible, 
often quite impel eeptibie, especially if the individual is lather fat "When 
the paiietes of the heait aie unnatuiallj’' thick, the impulse is iisiiallv so 
gieat as vei}'’ sensibly to elevate the head of the obseivei, and sometimes 
to give a disagreeable shock to the ear The more intense the hypeitiophia, 
the longer time the impulse is perceptible When the disease exists m a 
higli degree, we feel as if the heart, rn dilating, first comes in contact with 
the thoiaeic paiietes iii one point only, and then with its whole surface, 
and that it contracts and falls back all at once The impulse of the heart 
IS only felt during the systole of the ventricles, or if, in some lare cases, 
an analogous phenomenon accompanies the contraction of the auricles, 
this IS easily distinguished fiom the foimer In fact, when the systole of 
the auricles is attended by any sensible action, this is perceived to have 
its seat much deeper , and most commonly it consists merely of a soit of 
Mbiation In any ease, it is very little maiked as compared with the sensa- 
tion produced by tlie eonti action of the ventricles, when these are of a 
good degree of thiclnress 

When the paiietes of the heart are thinner than usual, no impulse is 
communicated, even rvhen the pulsation is the greatest, and, in this case, 
the alternate contraction of its cavities is only distinguished bj’’ the sound 
these produce A strong impulse, theicfoie, must be regarded as the chief 
sign of lupcitiophia, and the absence of all impulse as the characteristic 
of dilatation of the heart The correctness and constancy of this result 
hare been confiimed to me bv many examples 

Tlie inqnilse of the licait s action is usuallv perceptible only over the 
icinon of the licait or, at most, o\ei the infenor half of the sternum 
Wlicii rci\ gicat It extends to tlie epigastiium in eases vheie the steinum 
IS short In simple Inpeitiophia, it is usualh peicened in no otliei pait, 

[- 5 ] 



but when this is conjoined with a eeilain degiee of dilatation, it is some- 
times distinctly peiceived undei the clavicles, and in the light side of the 
chest The impulse of the heait’s action is, of couise, diminished by what- 
evei debilitates the geneial stiength of the system 

III Of the Sound Pi oduced hy the Action of the Ileai t 

The alternate conti action of the diffeient paits of the lieait pi educes a 
peculiai sound, of which the individual is himself sensible dining palpita- 
tion and in fevei In ceitaiii states of disease it can be lieaid at some dis- 
tance fiom the patient, but this is a veiy laie case The sound is the only 
phenomenon usually obseivable in any othei pait of the chest beside the 
piecoidial, the impulse of its action being confined, as alieady obseived, 
to that pait 

The sound pi oduced by the action of the heait is gieat in piopoition as 
the paiietes of the ventiicles aie Ihni and then impulse feeble conse- 
sequently, it cannot be attiibuled to the peicussion of this organ against 
the side In a model ate degiee of hyjieitiophia, the conti action of the 
ventiicles yields only a dull sound, like the muimiii of inspiiatioii, and 
the auiiele, in like mannei, a much less noise than in the natuial state 
In a high degiee of hjpeitiophia, the conti action of the ventiicles pioduees 
nieiely a shock without any sound, and the sound of the auiicles m seaicely 
audible On the othei hand, when the ventiiculai paiietes aie thin, the 
noise pi oduced by then conti action is cleai and loud, appioaching to that 
of the auiicles, and if theie be a maiked dilatation of the ventiicles, the 
sound becomes veiy similai, and almost as stioiig as that of the auiicles 

In the stale of health the sound of the conti actions of the heait is no- 
wheie lieaid so stiongly as in the xegion of the heait In ceitain states of 
disease it maj'’ be heaid moie distmctlj’- in othei places 

The soltenmg of the substance of the heait deadens the sound of its con- 
ti actions, as does also anj^ impediment of the ciiciilation, whethei caused 
by too much blood, oi by an obstacle in the aiiiiculo-ventiiculai oiifices 
This lattei state, fuithei, gives use to a dull lustling sound, veiy like 
the noise of bellows, oi (when stiongei) like that pi oduced by the action of 
a file on wood The paiticulai oiifice affected is, in this case, indicated 
by the place and time in which the sound is obseived When the oiifice 
is on the left side, we can sometimes feel with the hand a soit of vibiatoiy 
sensation like that produced by the puiiing of a cat In this case, the 
noise pi oduced by the conti action of the cavity having the obsti acted 
oiifice IS not only diillei, but much moie piolonged than in the natuial 
state 

IV Of the Bythm of the Pulsations of the Heai t 

By xythm I undei stand the oidei of the contractions of diffeient paits 
of the heait, and then relative duration and succession, as detected by 
the cylinder Before enteiing on this subject I think it necessary to notice 

[ 336 ] 



tlie lelative piopoitions of tlie lieait to the bodj^ of the individual, and of 
the diffeient paits of the heait to each other, in a state of health, and in a 
well piopoitioned suboect 

The heait, including the auiicles, ought to be of a size equal to the closed 
hand of the subject, oi only a little less or gieatei than it The walls of 
the left ventiicle ought to be of a thickness somewhat more than double 
that of the light The textuie of the left ventiicle, fiimer and more com- 
pact than that of the muscles, ought to keep it from collapsing when laid 
open The right ventricle ought to be a little laigei than the left, with 
columnae carneae of greater size, and ought to collapse on being cut into 
111 a heait so pi oportioned, the alternate coiiti actions of the ventiicles and 
amides, as examined by the cylinder, and the pulse as examined by the 
fingei, affoid the following lesiilts — 

At the moment of the aiterial pulse, the eai is slightly elevated by an 
isochronous motion of the heait, which is accompanied by a somewhat 
dull, though distinct sound This is the conti action of the ventricles Im- 
mediately aftei, and without any iiiteival, a noise lesembling that of a 
valve, 01 a whip, oi the lapping of a dog, announces the eonti action of 
the amide (I make use of these trivial expressions because they appear 
to me to express bettei than any desciiption, the nature of the sound in 
question ) Tins noise is accompanied by no motion perceptible by the 
ear, and is separated by no interval of lepose from the duller sound and 
motion indicative of the eoiiti action of the ventiicles, wliicli it seems, as 
it were, to inteiiupt abruptly The duration of this sound, and conse- 
quently the period of contraction of the amides, is less than that of the 
ventiicles, — an incontestible fact of which HaUei entei tamed doubts Im- 
mediatelj^ aftei the systole of the auricles theie is a very short, yet well- 
maiked interval of lepose, subsequently to which we feel the ventiicles 
swell anew, with the dull sound and gradual piogiession which chaiac- 
teiise then action, then follows the quick and sonorous conti action of the 
amides, and again the lenewed but momentaiy immobility of the heart 
This state of quietude after the contraction of the amides does not appear 
to have been known to Haller as a natuial condition The i dative dma- 
tion of the conti actions of the amides and ventricles, appeals to me to be 
as follous Dividing the whole into four parts, a fouith (oi thud) belongs 
to the systole of the amides, a fouith (or somewhat less) to the state of 
quiescence, and two-fouiths to the systole of the ventricles — These ob- 
seivations aie iiiost conveniently made when the pulse is slow 

Piom the foiegomg observations it appears that the heart, far from be- 
ing in a state of constant action, as is usually supposed, presents alterna- 
tions of action and lespose, the sum of which does not differ from those of 
many other muscles, more especially the diaphragm and niter costal muscles 
Prom the proportions aboie stated it follows that in tuenty-foui hours 

[ 337 ] 



the ventiicles have twelve, and the ainieles eighteen houis of quiescence 
In pel sons whose pulse is habitually below 50, the repose of the ventricles 
IS moie than sixteen houis in the foui-and-twenty 

Hypertiophia of the ventiicles, when in a model ate degree, presents, 
in some respects, an exaggeiation of the natuial lytlim of the heait’s ac- 
tion The eonti action of the ventiicles becomes less noisy, and moie 
leadily distinguishable fiom that of the auiicles Aftei the latter, the 
inteival of quiescence is well-maiked and contiasts veiy sensibly with the 
sound that pieeedes, and the motion which follows it But in hyper- 
tiophia earned to a veiy liigh degiec llic lyllim of the lieait is smgulaily 
changed 

In this case, the coiiti action of the ventiicles is gieatly piolonged This 
at fiist IS peiceived as a piofound and obscuie motion, which giadually 
augments, elevates the applied eai, and then teiminates in piodiicing the 
impulse 01 shock This con ti action is unaccompanied by any noise, or, if 
this exists, it IS meielj a soil of muimui like that of lespiiation 
The contiaetion of the auiicles is extiemely shoit, and almost, oi alto- 
gethei, without sound, and in some eases the systole of the xentiicles seems 
scaicely ovei befoie thej’- begin to swell afiesh 
In extieme eases theie is no sound distinguishable but the murmur 
above mentioned, and we meiely lecognise an elevation of the heait coi- 
lesponding to each beat of the pulse In these cases the inci eased brevity 
of the auiiculai contiaetion is not the consequence of then diminished 
contraetibility meiely, but, also, of then contiaetion commencing before 
that of the ventiicles has entiiely ceased 

When the walls of tlie left ventiicle aie natuially thin, or have become 
so fiom dilatation, the ijthm of the heait’s actions is quite dilfeient In 
this case, the inteival of lepose aftei the contiaetion of the auiicles is no 
longei peieeptible The contiaetion of the ventiicles is moie sonoious, 
moie lesemblmg that of the auricles, and moie approaching the lattei in 
duration In this condition of the heait, theie is as alieady obseived, 
a less degiee of impulse dining the contiaetion of the ventiicles, and a 
gieatei extent in the pulsation of the heait This condition of the organ 
of ciiculation is congenital in many cases It does not necessaiily abiidge 
life, but IS usually conjoined with a delicate constitution 

Actual dilatation of the heait pioduces meiely an ineiease of all the 
characteis which indicate a heait Avith thin paiietes The contiaetion of 
the ventricles becomes as shoit and noisy as that of the auiicles, the pulse, 
consequently, becomes veiy fiequent, and the isochronism of the aiteiial 
pulse and the contraction of the ventricles becomes quite indistinguish- 
able In addition to these signs we must add — ^the absence of any sensible 
impulse, the extension of the heart’s pulsation ovei the whole or greatei 
pait of the chest, and the existence of this in as great force undei the 

[338 ] 



clavicles and the axilla as in the legion of the heait itself This last charac- 
ter, particulaily, may be regarded as pathognomonic, if the patient is not 
phthisical and peetoiiloqiious in the places mentioned 

V Of Palpitahon of the Heai t 

By palpitation of the heart is meant, in the common language of medi- 
cine, every beating of the heart which is sensible and unpleasant to the in- 
dividual, and, at the same time, more frequent than natural When this 
affection is studied by the aid of the cylinder, %Ye find that there are manj’- 
varieties of it, all of which appear to have merely this one character in 
common, viz that the individual is sensible of the heart’s action Fie- 
quently, also, the patient heais the pulsation, especially when in the hori- 
zontal posture In the upright position, the contraction of the ventiicles 
only IS heard, while, when lying on the side, the individual is sensible of a 
pulsation of his ear double that of the pulse, viz the alternate contraction 
of both the ventricles and auricles In many eases there is merely an in- 
creased frequency of pulsation, although the patient imagines, from his 
sensations, that there is also great increase of force This species of pal- 
pitation is most common in dilatation of the ventiicles, and lasts the long- 
est of any I have known it continued eight days, the pulse lemaming, 
thiough the whole of this time, extremely small and weak, and between 
160 and 180 

Another variety consists in an increase both of frequency and force of 
pulsation Tins is what arises in healthy persons from great exertion or 
Irom moral causes, it also accompanies slight degrees of hypertiophia 
In simple hypertiophia in a high degree, the ventricles are found to con- 
tract with great force, and to elevate the thoracic parietes in an extent and 
to a height much greater than natural The noise, however, produced 
by their contraction is much duller and more indistinct than usual, the 
extent of thorax over which the pulsation is perceptible is not increased, 
and, notwithstanding the increase of the heart’s power to double or triple 
Its ordinary force, the pulse is, almost always, two or three times more 
feeble and smaller than in the natuial condition of the circulation In 
hypeitiophia with dilatation, the impulse, noise, and extent of the heart’s 
action, aie usually equally increased 

VI Of h 1 egulanty of the II ecu t’s Action 

Ii regularity in the pulsation of the heart may exist without palpita- 
tion In old persons this is often met with without any perceptible altera- 
tion of the geneial health The in egulanty which occurs rn palpitation 
consists usually in mere variations in the frequency of the heart’s pulsa- 
tion Sometimes this variation is almost eonstantly recurring, at other 
times it IS at longer intervals, and consists only of a few contractions 
longer or shoiter than the rest These iiiegulaiities occur most fre- 
quently 111 cases of dilatation 


[ 339 ] 



In lij^peitiophia, and dm mg the existence of palpitation, the conti ac- 
tions of the ventiicles aie so quick, and so much pi obliged, that those of 
the auiicles cannot be peiceived It sometimes, though veiy laiely, hap- 
pens duiiiig palpitation, that each coiitiaction of the ventiicles is followed 
by seveial successive conti actions of the aniicles, So quick as only to equal 
in point of time one oidiiiai}'' contiaction Sometimes these contractions 
aie two 01 foul, but most fiequently thiee 

VII Iniei mi'ision of ilic Puhaiion oj ilic II cat t 

iiilei mission, we usually undeisland a sudden and momentary sus- 
pension of the pulse, duiing whicli llie aiteiy is no longei peiceptible 
beneath the fiiigei Tlie duiation of the ml ei mission is very variable, 
and mai sene to divide tins affection into well-maiked vaiieties Some- 
times the inlei mission is slioilei than one aiteiial pulsation, sometimes 
it IS equal, and sometimes it is longei 

The first kind of mteimissioii is the most common, it is fiequent in old 
age, even duiiiig health At othei peiiods of life, it is onlj’’ obseived in 
ceitain diseased states of the lieait, paitieulaily hvpeitiophia By means 
of the stethoscope we asceitam tliat this species of inteimission always 
succeeds the coiitiaction of the auiiclcs It, theiefoie, only diffeis fiom 
the natuial quiescence aftei this coiitiaction, in the iiiegulaiity of its 
leeuiienee The duialion and lecuiience of this species of suspension of 
the heait’s action aie len vaiiable This, tlie leal inteimission, must be 
distinguished fiom the false inteimission, alieady noticed, pioduced by the 
vaiiation of the duiation and stiength ol the heait’s conti actions This can 
easily be done Ip the cAlindci The species of inteimission which consists 
111 the absence of one comjilete pulsation, letuining sometimes with an 
exact peiiodicity at longei oi shoitei inteiials, constitutes the sign deemed 
by Solano indicative oi the appioach of ciitical diaiihoea The thud 
vaiiety is accompanied bj' a state of fulness of the aiteiy duiing its con- 
tmuaiiee 

Many consideiations, some of which have been stated, piove that the 
meie examination of the pulse is insufficient to infoim us of the tiue state 
of the eii dilation, and must often lead us into eiioi — To notice only the 
indications affoided by it as to blood-letting, to piognosis in all diseases, 
and to diagnosis in seveial — 

We have seen, that, in peiipneumony and pleurisy, the absence of fevei 
and a peifeetly natuial state of the pulse, fiequently accompany an incur- 
able disease In diseases of the heait, the pulse is often feeble, sometimes 
even almost imperceptible, although the heait 's contiaction, that especially 
of the left ventiicle, is much inoie eneigetic than natuial In apoplexy, 
on the conti aijq we often meet with a veiy stiong pulse in peisons in 
whom the impulse of the heait’s action is scaieely obseivable These two 
opposite facts may easily be veiified by the use of the cjdindei , I have 

[ 340 ] 



myseli done so, peiliaps more than a thousand times, within the last thiee 
yeais They appeal quite inexplicable, unless we admit the arteiies to 
possess a power of action independent of that of the heait 

It would seem to be pioved, also, by many othei facts, that the diffeient 
systems subseiyient to the ciieulation, although necessaiily and lecipro- 
cally dependent, haye still, in othei lespects, a paitieulai or individual 
existence, ivliieh, in eeitain states of the disease and in ceitain indiyiduals, 
IS moie maiked and isolated than in oidinaiy cases and ciicumstanees 
This view of the case is suppoited by the obseivations of piactitioneis, in 
all ages, of the diffeient effects of bleeding, accoidiiig as it is geneial or 
local, venous or aiteiial, depletive oi deiivative The same is shown by 
the gieat benefit of a natuial hemoirhage of a few ounces only, and the 
inefficacj^ of copious venesection in the same case, and by the tiifiing 
degiee of exhaustion piodueed sometimes by veiy pi of use hemoiihage, 
compaied with the gieat collapse occasioned by the bleeding of a few 
leeches in the same peison These facts piove, I think, that the capillaiy 
cii dilation IS 111 some soit independent of the geneial The influence of 
the latter on the foimei seems very inconsideiable indeed in certain hein- 
orihages fiom the uteius, bowels, nose or lungs, which aie found to be veiy 
little affected by the most copious venesection 

The meie state of the pulse, then, is fai fiom indicating the state of 
the ciieulation in geneial, it does not even certainly indicate its condition 
in the whole heart, as it meiely coiiesponds with the con ti action of the 
left ventiicle, which may be legulai at the time when that of the auiicles 
and light yentiicle is iiiegulai In like mannei, the state of the pulse 
fails to be a suie guide as to the expediency of lilood-lettiiig Eyery one 
Icnows that in ceitain cases, foi instance in apoplexy, periimeumony, 
pleuiisy, and inflammatoiy affections of the abdomen, the weakness and 
snialhiess of the pulse do not always eontia-indicate venesection, on tlie 
coiitraiy, that the aitery, in such cases, lecoveis its foice and fulness aftei 
the loss of blood The lecognition of this kind of pulse {fichUte dehihs) 
is one of the most impoitant and difficult points in the tieatment of the 
acute diseases, as an eiioi in lespect of it may be fatal In eases of this 
soit, the stethoscope affoids a lule much suiei than the pulse Whenevei 
the conti action of the ventiicles is eneigetie, we may bleed without feai, — 
the pulse mil use, but if the contiactions of the heait aie feeble, although 
the pulse still letains a ceitain degiee of stiength, we must be cautious 
lespecting the emplovment of venesection 'When the pulse is veiy stiong, 
and the contiaclions of the heait modeiately stiong (as is fiequently the 
case 111 apoplexy ), we iiiav still bleed ivith advantage as long as theie is not 
a maiked diminution in the noise and impulse of the heait ’s actions But 
nheii both the pulse and the heait aie feeble, ne must not open a lein, 
whatever be the iiohic of the seat of the disease, as such piactice must in- 
falliblv destioy the few lesouiees still left to natuie The most we can 

[ 341 ] 



do, in such a case, if there be anj'- local congestion, is, to tiy, by the ap 
plication of a few leeches, if the patient can bear the subtraction of blood 
from the capillaries 

The ceitainty and facility with which the cylinder indicates the propri- 
ety of blood-letting in such cases as those above mentioned, (which have 
been hitheito eonsideied among the most difficult in practical medicine,) 
appeals to me to be the greatest advantage to be derived from the employ- 
ment of this instrument 

After what has been said, and aftei its general uneertamty avowed by 
the most experienced practitioners, it may seem suipiising that the practice 
of feeling the pulse has been so geneially followed in all ages The reason 
of this practice is, however, sufficiently obvious it is of easy performance, 
and gives little inconvenience eithei to the physician or patient, the 
cleverest, it is true, can derive fiom it but a few indications and uncertain 
conjectiues, but the most ignorant can, without exposing themselves, de- 
duce fiom it all sorts of indications Its veiy iineeitainty gives it a prefei- 
ence with persons of inferior qualifications, over means quite certain in 
then nature, and winch enable the non-piofessional observer to judge of 
the skill of the physician by the coiiectness of his diagnosis and prognosis 

The facts above slated relative to the discordance existing between the 
pulsation of the heart and of the aileiies, — moie especially as to strength, 
are coiitiaiy to the more general opinion of modern physiologists, who con- 
sider tJie action of the ai tones as enlnely dependent on that of the heait 
Bichat himself has fallen into this eiioi 


OF SYMPTOMS COMMON TO ALL THE DISEASES OF THE HEART 

These aie an habituallj" short and difficult lespnation, palpitations and 
oppression constantly produced by the action of ascending, by quick 
walking, bj’’ emotions of mind, — oi witliout any peicejitible cause, fright- 
ful di earns, and sleep fiequently disturbed bj' sudden starts, a cachectic 
paleness and a tendency to anasarca which, indeed, comes on after the dis- 
ease has persisted some time To these symptoms is fiequently added the 
angina pectons , — a nervous affection characterised by a sense of oppies- 
sion, constiiction and oppiessioii in tlie legion of the heait, and a pain oi 
numbness of the aim, more commonly of the left, sometimes of both at 
once When the disease has reached a high degree it is recognised at a 
single glance The patient, unable to bear the horizontal posture, remains 
night and day seated in his bed, Avith the face more oi less swollen, some- 
times very pale, but more commonly of a deep violet tint, either over the 
whole or only on the cheeks The lips are swollen and prominent, of a 
deeper violet than the rest of the face, or of this hue when it is quite pale 
The whole body is more oi less anasaicous The congestion and lentor of 

•Anat Gener 1 re part tom II page 371 

[342] 



the capillary ciieulation are fmther shown by affections of the internal 
oigans, for instance — ^haemoptysis, pains of the stomach, vomiting, ap- 
oplexy (which frequently teiminates such affections), and most of all, 
dyspnoea, which last symptom has been the cause of confounding such 
diseases (with many otheis) under the name of Asthma Emphysema of 
the lungs likewise bears much resemblance to some vaiieties of disease of 
the heart, but the following maiks will distinguish them fiom each othei 

In disease of the heart, the patient, although with the respiiation habitu- 
ally short, does not usually experience the feeling of oppression and 
dyspnoea, except when walking lathei quick, or using much exertion, oi, 
more particularly, when ascending an elevation 

On the othei hand, the individuals affected with emphysema, become op- 
pressed on the breath ivhen they are quite still and these attacks lecui 
without any known cause, or fiom a slight change of the weather Moder- 
ate exercise seems often to lelieve them, if the disease has not reached a 
gieat degree of intensity 

In diseases of the heart the general ciieulation is not always so much 
affected as the capillary Sometimes the pulse is almost natural, but is 
often irregular — At all events, it is evident that none of the general symp- 
toms already mentioned suffice to characterise disease of the heart, and 
that for a certain diagnosis we must recur to mediate auscultation It is 
necessary here to remark that the study of the physiological conditions of 
the heart, by means of the cylinder, requires much more time and applica- 
tion than that of the voice and respiration In hospital practice, also, 
omng to our general ignorance of the anterior history of patrents, we are 
liable to be led into error by its use, without proper care For example, 
we may, in some cases, consider a patient as labouring under hypertiophia 
or dilatation of the heart, when he is merely affected with nervous palpita- 
tions Another, and more insidious cause of mistake, arises in diseases 
which dimmish the extent of respiration, for instance, peripneumony, 
emphysema, and moie paiticulaily ehionic pleuiisj’- In cases of this kind 
I have sometimes found the heart enormously dilated and thickened after 
death, although, during life, its contractions had been perfectly natural 
111 respect of sound, impulse and lythm It would seem as if the 
diminished capacity of the lungs produced a diminished action of the heart 


OF HYPERTROPHIA, OR SIMPLE ENLARQEMENT OF THE HEART - 

By Hypertiophia I mean simple increase of the muscular substance of 
the heart, without a proportionate dilatation of its cavities, or even with 
a diminution of these This affection is by no means common, and appeals 
to have escaped the notice of ll Corvisait, as, through his whole work, he 

*BooK Third Chapter 1 Section First See note on page 332 F A W 1940 

[ 343 ] 



seems to considei enlaigement of the paiietes of the Iieait, as being nni- 
foimly accompanied a piopoitionate dilatation of the cavities of that 
01 gan 

This enlaigement of the heait is always attended by a considerable m- 
ciease of its consistence, except when conjointed with another affection 
of this 01 gan, to be noticed piesently, vi7 softening of the lieait 

Hj^peitiophia may exist in one oi both veiitiieles, with oi ivithout a 
similar affection of the aiiiicles Most commonly the amides aie not 
affected, but occasionally they aie so, while the veiiliicles aie sound 

When affecting the left venliicle, I have seen its paiietes moie than 
an inch thick at the base, that is, double tliat of its sound state Commonly, 
this moibid thickening diminishes insensilily fiom the base to the apex of 
the ventiiele, wheie it is scaiccty peiceptible, sometimes, howevei, the 
apex pai takes in the enlaigement, as I have seen it fiom two to foiii lines 
thick, which IS double oi quadiuple the natuial size The columnae caineae 
of the ventiiele and of the valves acquiie a piopoitionate enlaigement 
The septum between the two ventiielcs becomes also notably thickened m 
the disease of the left ventiiele, (which fact seems to maik it as belonging 
to this lathei than the olhei ventiiele,) but nevei so much so as the othei 
paits 

The iniiseulai substance in these cases is of a degiee of consistence some- 
times double the natuial, and is of leddei colour The eamty of the ven- 
tiiele appeals to have lost m capacity what its paiietes haie gamed to 
thickness Sometimes I have found this so small, in lieaits twice the size 
of the fist of the individual, as scaicely to be capable of containing an 
almond in its shell The iiglit Acntiicle, in such cases, is flattened along 
the septum, and docs not extend to the apex of the heait In extieme 
eases, it seems as if it iveie meiely included within the paiietes of the left 
ventiiele 

In hypeitioiihia of the light ventiiele the aiipeaiances aie someivliat 
diffeient The thickening is heie moie unifoim, and nevei so gieat as m 
the othei I have nevei found it gieatei than foiii oi five lines It is al- 
ways a little gieatei in the vicinity of the tiicuspid valves, and at the 
oiigin of the pulmonaiy aiteiy The columnae caineae aie much enlaiged, 
eonsidei ablj^ moie so, in piopoitioii, than those in tlie left, in disease of 
that side Simple enlaigement of the light ventiiele, -without dilatation, 
is much laier than that of the left When this disease affects both ven- 
tiicles at the same time, the only diffeience fiom the deseiiption just given 
IS, that each side assists to foim the apex of the heait 


HYPERTROPHIA OF THE LEFT VENTRICLE 

It IS to this vaiiety of the disease, especially, that the symptoms at- 
tiibuted by M Oorvisait to active anew ism of the heait, must be lefeired 

[3M3 



These aie, — a stiong full pulse, stiong and obvious pulsation of the heart, 
absence oi diminution of the sound afforded by percussion on the region 
of the lieait, and a tint of complexion lathei led than violet None of 
these symptoms, however, aie constant, and it is not uncommon to find 
the disease in persons who have none of them The pulse, in particular, 
IS very deceptive, being almost as frequently weak as stiong, in such 
cases 

The cylinder fuiiiishes signs which aie much moie constant and posi- 
tive The contraction of the left ventiiele, examined between the cartilages 
of the fifth and sixth iibs, gives a very stiong impulse, and is accompanied 
by a duller sound than natuial, it is moie prolonged in portion as the 
thickening is moie considerable The conti action of the auricle is veiy 
short, productive of little sound, and, consequently scarcely perceptible 
in extieme cases The pulsation of the heart is confined to a small ex- 
tent, being, in general, scarcely perceptible undei the left clavicle, or at 
the top of the steinum , sometimes it is confined to the point between the 
cartilages of the fifth and seventh ribs In this disease the patient ex- 
pel leiices, more constantly than m any other, the sensation of the action 
of the lieait, but he is less subject to violent attacks of palpitation, ex- 
cept from accidental causes, such as moral affections and violent bodily 
exertion In this case, during the palpitations, ii regularity and inter- 
mission of the pulse aie uncommon There is rather increase of the power 
of the ventricles than of the noise produced by then action 


HYPERTROPHIA OF THE RIQHT VENTRICLE 

Accoidmg to M Coivisait the sj^mptoms aie the same as when the dis- 
ease IS on the othei side, only that lespiiation is moie oppressed, and the 
colour of the face is deeper Lancisi has mentioned the swelling of the 
external jugulai veins, with a pulsation analogous to that of an artery, as 
a sign of the aiieuiism of the light ventricle M Corvisait has rejected 
this symptom, because, he says, “it has been found in cases where the 
left side of the lieait was dilated, and because the pulsation may be con- 
founded with that of the carotids ” In this opinion I differ from M 
Corvisart I have uniformly found this sjmiptom in every case of this 
kind, of any degiee of seventy, and I have never met mth it in hypei- 
tiophia of the left ventricle unless there existed, at the same time, a similar 
affection of the light I think a very bttle attention must distinguish 
this pulsation fiom that of the carotids I would, theiefoie, be disposed 
to regard this symptom as one which ought to lead us to suspect the ex- 
istence of the thickening of the light ventricle 

The coiiti actions of the lieait, as exploied by the eylindei, give the same 
lesiilts iieailv, whethei the hvpeitiophia be on the light oi left side, 
onlv, 111 the foimei case, the shock of the lieait ’s action is gieatei at the 

[ 345 ] 



bottom of the steinum than between the cartilages of the nils, which is 
the level se of what happens when llie disease is in the left side of the 
oigan In most men, in health, the heart is heaid equally in both these 
places, and I am disposed to believe, when heaid bettei below the sternmn, 
we may suspect an incipient h 3 >-peitiophia or dilatation of the right 
ventiicle When both ventiicles are affected, the s^miptoms of both co- 
exist, only those of the light side aie almost always moie maiked 


OF DILATATION OF THE VENTRICLES-* 

This disease of the heait, which has been named passive anew ism bj 
hi Coivisart, consists in dilatation of the cavities of the ventricles, with 
decieased thiekneas of then paiictes With these conditions theie are 
eommonlj’- conjoined a notable degioe of softeiiing of the muscular sub- 
stance, and a colour, eithei moie violet, oi palei, than natural Some- 
times the softness is so consideiable, esiiccially in the left ventricle, that 
the museulai substance can be destioyed bv meie piessuie between the 
fingeis, and the paiietes of the same ventiicle maj’’ be so much diminished 
111 thiclaiess, as to lie onlv two lines in the thickest point, and scarceh 
half a line at the apex, wdiilc the light ventiicle is sometimes so completely 
extenuated, as to appeal merely composed of a little fat and its investmg 
membiane Tlie columnae caineae, paiticnlaily of the left ventricle, are 
more i emote tlian in the iiatuial condition of the part The septum be 
tween the lentiielcs loses less of its thickness and of its consistence than 
the lest of the paiietes 

Dilatation may be confined to one Amntiiclc, although it moie commonly 
affects both at the same time When one onlj’- is affected, the apex of it 
extends lielow the other, but not in so lemaikable a degiee as in tlie case 
of hypeitiophia The augmentation of the cavitj’’ seems to be moie m its 
breadth than length This is paiticulaily observable when both the ven- 
tiieles aie dilated at the same time, as in this ease, the heait assumes a 
lounded shape, being neaily as wide at the apex as at the base 


DILATATION OF THE LEFT VENTRICLE 

The sj'mptoms of this affection, according to M Coivisait, aie — “a 
soft and weak pulse, and feeble palpitations — ^the hand applied to the 
legion of the heait feels as if a soft body elevated the iibs, and did not 
stiike these with a shaip and distinct stioke ” 

The only certain sign of the existence of this disease is that given bj’’ 
the stethoscope, viz the clear and sonoious contractions of the heait 
between the eaitilages of the fifth and seventh iibs The degiee of dis- 


*Book Third, Chaptei 1, Section Second See footnote on page 332 — F A W. 1910 

[346] 



tinetness of the sound, and its extent over the chest, aie the measure of 
the dilatation thus,— when the sound of the contraction of the ventricle 
IS as clear as that of the contraction of the auiiele, and if it is, at the same 
time, peiceptible on the right side of the back, the dilatation is extreme 


DILATATION OF THE RIGHT VENTRICLE 

Accoiding to M Corvisart, the state of the pulse and the pulsation of 
the heait aie veiy nearly the same as in dilatation of the left ventricle, 
only that the action of the heart is heaid somewhat better towards the bot- 
tom of the sternum than in the legion of the heart More ceitain symp- 
toms he considers to be — a gieatei degiee of oppression, more marked 
seious diathesis, moie fiequent haemoptysis, and a moie livid state of the 
countenance, — than in the affection of the left ventricle With regaid to 
the swollen state of the jugulars without pulsation, which M Coivisait 
consideis of little impoitanee, I am disposed to look upon it as the most 
constant and chai acteristic of the equivocal signs of this affection The 
only constant and truly pathognomonic sjonptom, however, is the loud 
sound of the heart perceived at the bottom of the sternum, and between the 
cartilages of the fifth and seventh ribs of the light side The degree of 
dilatation is measured by the extent of the action of the heart over the chest 
The palpitations which accompany this affection consist piincipally, in an 
inciease of the frequency and sound of the contractions, while, at the same 
time, the impulse of the heait ’s action is fiequently feebler than in the or- 
dinary state of the patient 


OF DILATATION COMBINED WITH HYPERTROPHIA 
OF THE VENTRICLES* 

This leunion, which constitutes the active aneuiisni of M Corvisart, is 
extieinety common, much moie common than simple dilatation, and still 
more so than simple thickening witliout dilatation This complication may 
exist in one oi both ventiicles In the lattei case the heart acquires a pro- 
digious size, sometimes moie tlian tuple that of the hand of the individual 
As the augmentation of volume is here the effect of dilatation and thicken- 
ing, tlie musculai substance acquires the great firmness already described 
The apex of the heart becomes blunter, but this is rarelj'- so great as to give 
to the oigan the lounded form noticed in the case of simple dilatation 

Dilatation of one Aentiicle is sometimes conjoined with hjqrertrophia 
of the othei, but this is not so common as the complication in individual 
^entlleles I have met until the following varieties of this complication 
Ist, ID peitioplna with the dilatation of the left ventricle, and simple dilata- 
0^ tbe light, 2nd, HMreitiophia uith dilatation of the left ventricle, 

•Book Third Chaptei 1, Section Third See footnote on page 332 F A W 19-10 

[147] 



and simple hjqieitiopliia of the light, 3icl, II^Tieitiophia with dilatation oi 
the light, and simple dilatation of the left, 4th, Hypeitiopliia of the light, 
with dilatation of the left this last is the laiest I do not lemembei to 
have met with hypeitiophia of the left ventiicle (with oi without dilata- 
tion) complicated with dilatation of tJie light I would even be disposed to 
considei such a union as impossible 

In this case theie is a combination of the symptoms of two affections 
The conti actions of the ventiicles yield at the same time a stiong impulse 
and a veiy maiked sound, and they aie felt widely ovei the chest Wlien 
palpitation is piesent, the hand applied to the legioii of the heait is foicibly 
laised Even in the absence of palpitation, if A\e obseive the patient, we 
find his head, limbs, and even liis bed-clothes sliaken at each conti action of 
the heait The beating of the aiteiics is often visible 


DILATATION OF ONE OF THE VENTRICLES WITH 
HYPERTROPHIA OF THE OTHER 

The signs of this complication aie — a mixtuic of those common to each 
affection, with piedominanee of those belonging to tlie one of gieatei in- 
tensity They aie to be discoieied by compaiing the two sides of the heait 
togethei In this case, liovcvei, the indications of tlie cyhndei must he 
taken in conjunction witli those of the geneial symptoms of disease, else ve 
shall be led into eiioi 


DILATATION OF THE AURICLES'’ 

Dilatation of the auiicles is an cxtiemelj’’ laie disease, and it appeals 
still moie so compaied with the fiequency of the same affection of the 
ventiicles Sometimes we find in subjects affected with l^peitiophia oi 
dilatation of the ventiicles, the auiieles also piopoitionably enlaiged, it is, 
howevei, much moie common to find these letaining then natuial size 
even in eases wheie the ventiicles aie enoimously enlaiged Sometimes 
also, but moie laiely still, the auiicles aie dilated when the ventiicles aie of 
the natuial size 

Befoie we can judge of the extent of this affection ve must have piecise 
ideas lespecting the natuial piopoition of the vaiious cainties of the heait 
As far as the cavities aie conceined, we must admit that they aie veij^ iieailj 
of equal size, but as the paiietes of the auiicles aie much thmnei than those 
of the ventiicles, the foimei, when simply full and not distended, compose 
only about one-third of the whole oigan, — in othei woids, the size of the 
auiicles IS about one-half that of the ventiicles Both the auiicles have 
the same capacity, although some anatomists have considei ed the light 

"Boole Thud Chapter 1 Section Fourth See footnote on page 332 — F A W, 1940 

[348 ] 



laigei, no doubt misled by the gieatei length of its sinus, and moie es- 
pecially by the distended condition in which it is commonly found aftei 
death A siinilai distention, though moie laiely, takes place also in the 
left auiicle, and this accidental and tempoiaiy enlargement is sometimes so 
consideiable, owing to the gieat extensibility of the auiiculai stiucture, as 
almost to equal the size of the veiitiieles In oidei to distinguish the leal 
fiom the factitious dilatation, we have only to empty the auiicles thiough 
the vessels that entei into them, when, in the lattei case, these cavities will 
immediately lesiune then natural size, and, in the former, they will still 
neaily retain then acquned volume There is likewise another mark by 
which we can at once disci iminate the enlargement pioduced by the ac- 
cumulation of blood dining the few last hours of life, fiom the peima- 
nent inciease of capacity of the auiieles In the fiist case, the parietes of 
the auiicles aie gieatly distended by the contained blood, and the coloui 
of this appeals through the thinnest poitions, while, in the lattei, the 
auiicles although veiy voluminous, are still capable of containing moie 
blood, and then paiietes lemain opaque 
I have never met with decided dilatation of the auiicles without some 
thickening of then walls, and, on the other hand, I have never seen 
thickening of then walls without an augmentation of then capacity I 
may heie lemaik that it requiies much expeiience to judge coirectly of 
hypeitrophia of the auiicles, as, owing to their gieat natuial thinness, a 
considerable inciease (say double the natuial thickness, and the inciease 
IS raiely so much) is not obvious to a peison little accustomed to such 
examinations 

The most common cause of dilatation of the left auricle is the coiiti ac- 
tion of the oiifiee between it and the ventricle, in consequence of eai- 
tilagnious 01 bony mduiation of the initial valve, oi of cai uncles on its 
sin face The same causes sometimes occasion the letraction of this valve, 
and consequently, the peimanent patency of the auiiculoventiieulai 
oiifice In this ease dilatation and thickening may aiise fiom the meie 
action of the ventiicle on the auiicle I have nevei seen any change in 
the auiicles without some alteiation in the valves Dilatation of the light 
auiicle is most commonly the consequence of thickening of the right 
ventricle The diseases of the lungs winch M Coivisait leckons among 
the ordinal y causes of this dilatation, seem to me to pioduee, in geneial, 
meiely the accidental distention above noticed 

The symptoms of this atfection aie obseiue M Coivisait does not dis- 
tinguish them fiom those of the coiiespouding ventiicle I have not mj’-- 
self had yet sufficient expeiience of the use of the stethoscope m this af- 
fection, to speak confidentlv on the subject I think, howevei, theie can 
be little doubt that the signs affoided by it must be confounded with 
those aiising fiom the disease of the i entrieles, oi of the valves, of which 
the aiuiculai aftection is the consequence 

[349 3 



Of paitial dilatation of the heait, and of the induration of its sub- 
stance, I have nothing to say in this place 

PARTIAL DILATATION OF THE HEART’ 

M Coivisait found, in the peison of a young negio who died fiom 
suffocation, a paitial dilatation of the left ventiicle which was truly 
aneuiisniatical “On the supeiioi and latex al pait of this ^ entiicle there 
was a tumour almost as laige as the heait itself — The interior of this 
tumoiu contained several layeis of coagulated blood, veiy dense, and ex- 
actly like those found in aneuiisms of the limbs The cavity of this 
tumoui, communicated with the ventiicle by a small opening, smooth and 
polished ”t A similai case is cited b3’- M Coivisait fiom the IL^scell Nat 
Cxinos I have mj^self nevei met vith anytliing of the kind 
Theie is anothei laie species of dilatation desciibed by Moiand,f a sec- 
ond case of which Avas communicated bj' me to tlie Soc de la Faeult de 
Med § This is a dilatation foimed in the middle of one of the lips of the 
mitial valve, lesembling a thimble, oi gIo\e-fingei piojecting into the 
auricle 

Theie is still one othei vaiiety of paitial dilatation of the heait, Avhicli 
I have several times met amHi, and which is piobablj^, in a gieat measuie, 
the lesult of oiiginal matfoi maUon In the natuial confoimation of the 
heait, the light ventiicle seems to consist of tivo distinct paits united to- 
gether, the one of uhich descends lowaids the apex of the heait, ivliile the 
othei, almost at light angles to the foimei, is diieeted to the left side, 
and foiAvaids towaids tlie piilmonai^' aiteiy The dilatation to which I 
now allude, seemed to exist in both these divisions, while the point of union 
of the two letained its natuial dunensioiis It is, liowevei, more common 
to find the anteiioi oi pulmonaij'- diAusion of the ventiicle dilated without 
the othei poition, and in eveij’’ case of dilatation of this ventricle, the 
formei poition is ahvajs moie dilated than the othei This diffeience be- 
comes still moie evident Avhen the dilatation is conjoined with a ceitain de- 
giee of thickening, as, in this case, the pulmonaij’- poition of the ventiicle 
fiequentlj’- acquiies such a degiee of fiimness that its paiietes do not col- 
lapse when laid open, a thing which haidh'^ evei happens to the loivei poi- 
tion of the ventiicle 

INDURATION OF THE HEARTH 

I have alieady obseived that, in thickening of the heait, the miisculai 
substance possesses an unusual degiee of fiimness and consistence Coivi- 
sait has seen this so gieat, that the heait sounded like hoin ivlien stiiick, 

♦Book Third Chapter 1 Section Fifth See footnote on pase 332 — F A 1940 

top Cit p 283 

JHist de lacad des Sc 1729 

§Bulletin, No 14 

IIBook Third Chapter 1, Section Si\th See footnote on pag-e 332 — F A W, loiu 

[ 350 ] 



and the scalpel experienced gieat resistance in cutting it However, the 
mnscnlar substance of the heart “retained its natiual colour, and did not 
appear to be converted either into the bony or cartilaginous tissue ” I 
have never met with this species of induration, although M Corvisait has 
seveial times I consider it as the last degree of hypertiophia 

SOFTENINQ OF THE HEARJ-^ 

I have already noticed this condition of the heart In it the muscular sub- 
stance IS sometimes so soft as to be almost friable, the fingers passing 
easily through the paiietes of the ventricles Whatever may have been the 
patient’s disease, the heart is rarely filled with blood, and the ventricles 
equally collapse whatsoever maj^' be then varying thickness This affec- 
tion of the heart is almost alwaj'-s attended by some change of colour in the 
organ Sometimes this is deeper, and even quite violet, and this is par- 
ticulaity the case in fevers of the kind named adynmmque by Pinel More 
commonly, however, the softening of the heart is attended by a striking 
loss of colour, so as to resemble the palest dead leaf This pale or yellowish 
tint does not always occupj’’ the whole thickness of the lieai t , sometimes it 
is strongly marked in the cential portions, and veiy little on the exteiioi 
01 interior surfaces Frequently the left ventricle and interventricular 
septum exhibit this appearance, while the right ventricle retains its natural 
colour, and even a degree of firmness greater than natural Again, we some- 
times find here and there spots of the natural colour and consistence in 
hearts which are, everywhere else, much softened and quite yellowish This 
variety of yellowish softening is particularly observable in those cases where 
dilatation is conjoined with a slight degree of thickening It is also found 
111 simple dilatation, although it is more common to find this state accom- 
panied by that species of softening which is marked by an augmentation of 
the natuial colour of the organ There is a third variety of softening of the 
heait, which rvill be noticed in another place, and which is attended by a 
pale white colour of the muscular substance In this, the degiee of softening 
never reaches that of fiiableness, often it is scaicely perceptible, but the 
parts are flabby, and the paiietes of the ventiicles quite fall together on 
being opened This condition will be noticed undei the head of inflam- 
mation of the peiicaidium, as it is peculiar to that disease 

It would seem that the softening of the heait discovered in subjects 
whose death has been very gradual, is an acute affection, it is evidently 
still moie so where it exists only partially in the substance of the organ 
On the eontiaie, in cases where the heart is softened and yellowish through- 
out, it IS probable that the affection has existed foi a long time The deep- 
colouied softness obseived in subjects dead of fever, may, I think be com- 
pared to that adhesive softness of tlie other muscles often observed in these 
cases, and vliicli is also accompanied bv a degiee of redness greater than 

•Book Tliird Chiptor 1 Section Se\onth See footnote on page 332 P A. W'’, 1910 

[3513 



natuial This softening of the lieait, as well as the analogous glueij or 
fishy (gluant ou poisseux) state of the muscles, is paiticularly observable 
in putnd feveis, paiticularly when these exhibit the phenomena formerly 
considered as marks of putridity — viz livid intumescence of the face, 
softening of the bps, gums, and inteinal membiane of the mouth, black 
coating on the tongue and gums, earthy aspect of the skin, distended ab- 
domen and veiy fetid dejections I cannot assert that this softening of the 
heart exists in all kinds of continued feveis, but I have met with it con- 
stantly 111 such cases as I have attended to Could it account for that fre- 
quency of pulse which exists, sometimes for several weeks in convales- 
cence f 10111 feveis, although the patient eonlmiies to regain flesh and 
vigour ^ 

Cases of total softening of the heart aie usually accompanied by a cer- 
tain degree of cachexy, even when the individuals are otheiwise in toler- 
able health When sueli subjects are attacked ruth dilatation oi hypei- 
tiophia of the heart, as almost always happens, they do not present the 
usual swollen and livid state of the face obseiiable m other cases of this 
sort 

When softening exists along with dilatation of the ventricles, the sound 
produced by the contraction of these cavities, although loud, is yet dull, 
and without the clearness which attends common dilatation Wlien it is 
complicated with hyper tiophia, the sound of the contraction of the ven- 
tricles IS so obtuse as to be neaily inaudible, and m extieme cases, the im- 
pulse of the hear t is attended by no noise whatever 

ATROPHY OF THE HEART 

It is an important question whether the heart be susceptible of dinrinu- 
tioii of size and power like othei muscles, and, if so, whether this affords 
any hope of cure, by debilitating measures, in cases of hjpeitiophia This 
much IS ceitain, that, in eases where there is much emaciation, as in 
Phthisis and Cancel, the heart is generally found small Prom this con- 
sideration, I have in many cases of hyper tiophia attempted the method of 
cure proposed bj^ Valsalva in aneuiisin Almost all my patients got shortly 
tried of the extieme seventy of the regimen, and alarmed by the frequency 
of the bleedings In three cases, however, I have been so far successful 
that I am led to believe that this disease is not entnelj'- bejmiid the re- 
sources of art and nature Two of these were young rromen, the one twelve 
and the other eighteen years of age, both of whom presented symptoms of 
hyper tiophia in a high degree The privation of one-half of then ordinary 
diet, and some occasional general and local bleedings effected the gradual 
diminution, and, eventually, the complete cessation of all then sjuiiptoms 
The youngest has now been cured for four years, and has long ago returned 
to her usual regimen The other still follows the prescribed regimen, and is 

♦Book Third Chapter 1, Section Eighth See footnote on page 332 — F A W , 1S40 

[ 352 ] 



now quite leeoneiled to the dmiimshed quantity of food Blood-letting has 
not been found necessary for the last year, and the geneial sjunptoms of 
the disease have disappeared, although the unnatural thickness of the 
paiietes of the heait is still lecognizable by stethoscope The third case is 
snll more conclusive, as I have been enabled to ascertain the state of the 
heart aftei death I shall therefoie state it more particularly 

Case 42 A woman, fifty years of age, had been affected foi twelve j^'eais 
until all the symptoms of disease of the heart, in a very high degree, viz 
strong and fiequent palpitations, habitual dj^spnoea, breathlessness on using 
the least exercise, sudden stai tings from sleep, ahnost constant edema of 
the lowei extremities, and lividity of the cheeks, nose, and lips These 
symptoms had inci eased dining the last year, so that she could scarcely 
move from hei chan without the feeling of suffocation In this state I 
lecommended the tieatment of Valsalva, which she agieed to I immedia- 
ately reduced hei aliments to one-fouith of hei foimer allowance, and bled 
hei once a foitnight, eithei from the arm or by leeches This niode of 
treatment gave immediate relief, and in the course of six months all the 
symptoms had disappeared, and, with the exception of debility (which 
howevei was not gieatei than it had been previously), she enjoyed a bettei 
state of health than for many years before The lespiiation was now fiee, 
and the palpitations, oedema, staitings, and lividity of the face had quite 
disappeared Aftei this I recommended the bleedings to be decreased in 
frequency, and I dispensed with them altogether at the end of a year She 
also returned gradually to hei old regimen, only that now a much smaller 
quantity of food satisfied hei appetite She lived two yeais in a state of 
perfect health, when she was suddenly carried off by an epidemic cholera 
Upon examining the body after death I found the heart considerably less 
than the closed hand of the individual, being only about the usual size of 
that of a child twelve years old, although this woman was five feet thiee 
inches in height The exterior of the heart resembled, m appearance, a 
withered apple, the uu inkles running longitudinally The ventricular 
paiietes were flaccid, but without any notable softening, and of the natural 
thickness I am well aware that nothing can be deduced from a single 
case, but I have thought the above relation might be useful by stimulating 
others to prosecute this subject more at length 

FATTY DEQENERATION OF THE HEART-^ 

In medical writings we find many examples of the heart being over- 
loaded with fat in a surprising manner, and to which change of stiuetuie 
raiious svmptonrs, and even sudden death of the individuals, weie at- 
tributed j\r Comsart thinks that an enormous accumulation of fat around 
the heart may, in fact, produce such effects, although he has met with no 
01 other permanent derangement, m persons whose hearts veie 

•Book Thiul, Clnptor 1 ‘^ectjon Xmth ‘^ee footnote on page 332 r A W 3510 

[ 353 ] 



found to be much loaded in this manner I have also met with a great 
many eases of hearts, overloaded in this manner, in subjects dead of various 
diseases In these the fat was deposited between the muscular substance of 
the heart and the investing pericardium, and chiefly at the union of the 
auricles and ventricles, at the oiigin of the great vessels, and along the 
tract of the coronary arteries, also along the two edges and at the apex of 
the heart Sometimes the posterioi face of the light ventricle is covered 
by this deposition in its whole extent, a circumstance Avhich rarely has 
place on the surface of the left ventricle 

The fatter the heart is, the thinner, in geneial, are its parietes Some- 
times these are extremely thin, especially at the apex of the ventricles and 
the posterior side of the right ventricle On examining ventricles affected 
in this manner, they present the usual appearance internally , hut on cut- 
ting into them from without, the scalpel seems to leach the cavity without 
encountering almost anj^ muscular substance, the columnae carneae ap- 
pearing merely as if bound together by the internal lining membrane In 
these cases the fat does not appear to be the product of degeneration of the 
muscular fibres, as these can be separated by dissection Sometimes, in- 
deed, portions of fat penetiate deeply betiveen the muscular fibres, but, 
even in this case, the distinction between the two tissues is still very 
marked, and they are confounded by no mutual gradation of colour oi 
consistence It would seem piobable from this, that, from pressure oi 
some unknoivn aberration of the pouers of nutrition, the muscular sub- 
stance has wasted in proportion as the investing fat has inci eased It 
would seem reasonable to expect luptuie of the heait fiom an affection of 
this kind, such an instance, howevei, has never occurred to me Very 
commonly we find, in such subjects, a large quantity of fat in the lower 
part of the mediastinum, paiticulaily between the pericaidium and pleuia 
This fat, much leddened by its small vessels, and coveied by its pleura, as- 
sumes the figure of a cock’s comb and is firm The fat suiiounding the 
heart, on the contrary, is almost always of a pale yellow colour I have 
not observed, any more than M Coivisart, any symptoms that could di- 
rectly denote the existence of an accumulation of this sort I apprehend 
it must exist in a veiy great degree before it gave rise to any serious com- 
plaint This IS not, therefore, the condition I wish to denote by the name 
of Fatty degenei ation of the Heait This latter is an actual transfoima- 
tion of the muscular substance into a substance possessing most of the 
chemical and physical properties of fat It is precisely similai to the fatty 
degeneiation of the muscles obseived by Hallei,'®" and Vicq-d’Azyrt I 
have only met with it in a small portion of the heart at one time, and 
only towards the apex In these portions the natural red coloui is super- 
seded by a pale yellow like that of a dead leaf This change of structuie 
appears to proceed from without inwards Neai the internal surface of 


•Opusc Pathol 
fTom V 


[ 354 ] 



the ventricles, the mnsciilar texture is still very distinguishable, moie ex- 
ternally, it IS less so, and still neaier the suiface it becomes giadually con- 
founded, both in coloui and consistence, with the natural fat of the apex 
of the heart In such cases, howevei, even the poitions that still letain 
most of the muscular chaiactei, when compressed between two pieces of 
papei, still grease these very much This character distinguishes this 
species of degeneration fiom simple softening of the viseus I have never 
found rupture of the heart attributable to this change, any more than to 
the morbid accumulation of fat It is denoted by no symptoms with which 
I am acquainted 

CARTILAQINOUS OR BONY INDURATION OF THE MUSCULAR 
SUBSTANCE OF THE HEART* 

I have never met with ossification of the musculai substance of the heart, 
and only a small number of examples of this aie on record M Corvisart 
found, in the case of a man who died of hypertrophia of the left ventricle, 
the whole apex of the heait, and more partially the columnae eaineae, 
converted into eaitilage (Op eit ) 

Haller (Opuse Pathol ) found, in a child, whose heart was of the natuial 
size, the mferioi part of the right ventricle, the most muscular parts of 
the left auricle, and the sigmoid valves of the aoita and pulmonary artery, 
in a state of ossification SI Renauldin has published, in the Journal de 
Med for 1816, a very inteiesting ease of the same kind The patient was a 
man thirty-three years of age, much addicted to study, and subject to 
violent palpitations on the slightest motion “On applying the hand to 
the region of the heart a soit of motion of the ribs ivas felt, and even the 
slightest piessure produced very acute pain, which lasted long after the 
piessuie was discontinued On examining the body after death the heart 
was found extremely haid and heavy On attempting to cut the left ven- 
tricle great lesistaiiee was found, owing to the total conversion of the 
muscular fibre into a sort of petnf action, having m some places a sandy 
character, in others a resemblance to saline ciystallization The grains of 
this species of sand weie veiy contiguous to each other, and became larger 
towaids the interior of the ventricle They were continuous with the 
columnae caineae, which weie themselves converted into a similar sub- 
stance, but still retained then oiiginal foim, only much enlaiged Some of 
these sabulous concietions Avere of the size of the point of the little finger, 
and resembled small stalactites shooting in diffeient diiections The A’^en- 
tiicle Avas thickened The right A^entiiele and gieat aiteiial trunks Avere 
sound The tempoial and maxillaiy artenes, and also a pait of both the 
ladial aitenes AA^eie ossified ” ^Ye fiequently find on the inteiior surface 
of the ventricles, especially the left, eaitilagmous scales continuous AAuth 

•Book Tliiul Cimiiter i Section Tenth See footnote on page 332 — F A W, 1940 

[355] 



the lining membiane, and appaiently deposited between it and the miisculai 
substance of the heart These aie gen ei ally small I liaye nevei found 
them ossified 

OF CARDITIS^ 

Infiammation of the heait is a laie affection, and is, consequently veiy 
impel fectlj'' known both in a piactical and pathological view Theie are 
two yaneties of it, the geneial, or tliat affecting the whole heail, and the 
partial, or that confined to a smaU extent of it Theie peihaps does not 
exist on lecoid a satisfactoiy case of geneial inflammation of the heait, 
eithei acute oi chionie The gieatei numbei of cases so called, and particii- 
lailj'^ those given bj’’ J\I Coivisait, aie evidentlj’- instances of Peiicaiditis at- 
tended by that degiee of diseoloiation of llie heait wliicli we shall find fie- 
quently to accompany that affection Nothing pioves that the paleness of 
the heait in such eases is the consequence oi infiammation The affection 
generally inci eases both the ledness and density of the paits which it 
occupies, — but the diseoloiation in the eases alluded to is conjoined, in 
geneial, with a peiceptible softening oi the heait It is fuithei obseiv- 
able that, in these cases, peiieaidium was filled with pus while not a 
paiticle was found in the substance of the heait itself, now, pus must be 
consideied as the most unequnocal indication of inflammation The only 
case which I have met with of geneial inflammation of the heait possessing 
this unequivocal maik, is noticed bj^ Bleckel in the Mem de TAcad de 
Beiliii But this case is deseiibed with so little piecision, as meiely to 
piove the possibility of the fact, and affoids no help towaids a geneial de- 
sciiption of the disease 

Instances of paitial inflammation of the heait, chaiacteiized by the 
presence of an abscess oi ulcei in its paiietes, aie much moie common 
Bonetus has lecoided a good many such cases m his Scpulclii etum I have 
only met with one instance of the kind In tins (in a child twelve yeais 
old) the abscess was situated in the paiietes of the left veiitiicle, and might 
have contained a filbeit it was complicated with peiicaiditis In anothei 
case, of a man of sixty yeais old, I fotind an albuminous exudation, of the 
consistence of boiled white of egg, hnd of the coloiii of pus, deposited 
among the musculai fibies of the left ventiicle The patient had piesented 
sjuiiptoms of an acute inflammation of some of the thoiacic visceia, without 
piecisely indicating its site Oithopnoea, and a feeling of inexpressible 
anguish, had been the chief symptoms 

Ulcers of the heart have been still more frequently observed than ab- 
scess, they have been met with in its external and internal surface f All 
the cases, however, recorded under this name are not quite correctly desig- 
nated In the Sepulcht etwn we frequently find a case of pericarditis, 
attended with a i ough and uneven pseudo-membranous exudation, mistaken 

*Book Third Chapter 1 Section Eleventh See footnote on page 332 —P A W 1940 

fMorgagni, Epist XXV 


[ 356 ] 



foi an nlcei of the exterior smface of the heart This has been noticed by 
Itloigagni (Epist 20 and 25) That tiue ulcers of this surface, however, 
have been observed, is beyond doubt A case of this kind is described by 
Olaus-Boiiichius in the following words ‘^Coidis exterior caio, pro- 
funde exiesa, in lacimas et villos cameos putieseentes abierat,’ * and 
simiiai cases aie recoided bv Peyeif and Graetz | Ulceis on the mteiioi 
surfaces of the heait are perhaps more common than on the external, or, 
at least, theie are on record a gieatei numbei of ineontestible examples of 
the former Boiietus, Moigagni and Senac have collected a great many of 
these I have myself only met with one ease of this kind The ulcer was 
on the internal suiface of the left ventricle, and was an inch long by half 
an inch wide, and was more than four lines deep in its centre This pa- 
tient had laboured under hj^peitiophia of the left ventricle, which had been 
leeognised before death this was occasioned by rupture of the ventricle 
This teirible and, foitunately, veiy rare accident, is almost always the 
result of ulceiation of the ventiiculai parietes Moiand has collected 
several cases of this kind m the Mem de I’Acad des Sciences for the 1732, 
and Moigagni has described a similar instance — (Epist 27) 

Ruptiiie of the heart fiom violent exertion, without previous ulceiation, 
IS much laiei still, and the number of ineontestible examples of this is 
very small Several cases, recorded as such, aie so imperfectly desciibed, 
as to leaie a doubt whether the alleged ruptuie might not have been rathei 
the consequence of the incisions of an inexpert dissector The best authenti- 
cated examples of this kind of lupture are those given by Haller (Elem 
Physiol ) and Morgagni (Epist 27) 

It IS suipiismg that the gieat thinness of the parietes of the ventiicles, 
in the cases of aceuraulatioii of fat, does not give rise to rupture, more 
especially towards the apex and posterior part of the right ventiiele This 
is, however, so far from being the case, that ruptuies of the right ventiicle 
aie much raiei than those of the left, and that, m this last, the ruptuie, 
when It occurs, is very larely towards the apex 
SI Coivisait has given, foi the first time, examples of another species 
of 1 up tine of the heart, of a less certainly dangerous nature, — that, namely, 
oi the tendons and fleshy pillars of the valves § 

In the three cases related by him the ruptuie appears to have been the 
consequence of violent efforts in lifting great weights, etc A sudden and 
lery intense feeling of suffocation was the immediate result of this acci- 
dent, which teiminated in exhibiting all the usual symptoms of disease of 
the heait I shall have occasion to notice in a subsequent section a case of 
tlie same kind, only produced, appaientlv, bv ulceiation of the tendons 

•Scpulcluet Hb II Ob': S6 
tlbid ‘Sect 11 Obs 21 

cle Hn<1i periCTuI Sect 2 
^Cor\is\it on the Heut Ob': 33, 10 anti 41 

[ 357 ] 



In the piesent state of our knowledge it is impossible to ascertain the 
existence of either an abscess oi ulcer of the heart 

OF CARTILAQINOUS AND BONY INDURATION OF THE 
VALVES OF THE HEART^ 

The mitral and sigmoid valves of the aorta are subject to become the site 
of cartilaginous or bony pioductions, which increase their thicloiess, alter 
then shape, and obstiuet, sometimes almost totallj’’, the orifices in which 
they are placed The tricuspid and sigmoid valves of the jiulmonaiy artery 
arc much less subject to these alterations, altliough they are not quite ex- 
empt from them, as Bichat thought Morgagni found (Epist 37), in the 
case of an old woman, both these pai tially indurated He likeivise found, in 
a jmung woman, the sigmoid valves of the pulmonaiy aitery agglutinated 
by means of a caitilaginous indination, paitly ossified, so as considerably 
to diminish the diametei of the ai tery M Corvisai t has twice met with a 
cartilaginous induiation of the base of the tiicuspid valve, and I have 
mj^self sometimes observed slight caitilaginous incrustations, both at the 
base, and on the points of this valve I am not, howevei, aware that any 
one has found these indurated poitions completely ossified, nor do I be- 
lieve that the induiation has evei been so considerable as to occasion a 
serious state of disease Foi these icasons I shall confine my lemaiks to 
the valves of the left ventiicle 

The caitilaginous induiation of the mitial valve is sometimes confined 
to the fibious bands found in its base In this case it has the appeal ance of 
a very smooth, though unequal loll, lessening the oiifiee m which it is situ- 
ated This sometimes lias the consistence of peifect caitilage, sometimes 
only that of imperfect cartilage Similai incrustations sometimes are met 
with in othex paits of these valves The bony induiations present the same 
characters as to situation and inequality of thicloiess Though formed in 
the interior of the valve, they often project fiom it quite uncovered These 
ossifications are nevei peifect bone, they are whitei and more opaque, more 
fragile, evidently contain a gi eater propoition of phosphat of lime On 
this account they have been frequently named stones oi calcnh In fact, 
they frequently beai a striking lesemblance to small pieces of stone, of 
very irregulai surface, recently bioken When they are situated in the 
floating extiemities of the valve, these are sometimes united together, so 
as to reduce the orifice to a meie slit, which will, sometimes scarcely ad- 
mit the blade of a loiife oi a goose-quill M Coivisait found the orifice 
between the auiicle and ventricle reduced to a channel three lines wide, and 
bent like the canalis caroticus, fiom the thickening of the ossified mitral 
valves Sometimes, though rarely, the tendinous cords of the mitral valve 
are affected in the same mannei , and M Coivisait in one case found the 
whole of one of its pillais ossified t 

‘Book Third, Chapter 1 Section Twelfth See footnote on page 332 — F A W. 19-40 

top cit , p 212, 214 


[358 ] 



The ossification of the sigmoid valves of the aorta may commence, like 
that of the mitial, m their base of their loose edges, —and much more fre- 
quently in one of these situations than in the intermediate portion When 
in the loose extremity, the ossification seems most frequently to originate 
in the small tubercles known by the name of the Coipoia Sesamoidea 
When the ossification is confined to the floating edge of the valves, or 
when the base though ossified is little thickened, the valve may still per- 
form its functions, provided the middle poition of it be still sound But 
when the ossification is extensive, the valves glow together, and get in- 
curvated, eithei towards then concave oi convex side, so as to acquire the 
appearance of eeitain shells In this state they are immoveable, being 
either fixed on the side of the aoita, or in the orifice of the ventricle Very 
frequently, of the three valves one is bent in a direction opposite that of 
the two otheis In one case, M Corvisart found all the thiee valves ossified 
in their closed position so as to leave merely an extremely small slit for the 
passage of the blood The evil of this was partly obviated by one of the 
valves, although ossified and very thick, still retaining, at its base, suf- 
ficient mobility to allow an increase of one oi two lines to the oiifice during 
the action of the heait 

The symptoms oi ossification of the mitral valve are somewhat different 
fiom those attending the same affection of the sigmoid According to M 
Corvisart the principal sign of the former lesion is “a peculiar rustling 
sensation, peiceived on the application of the hand to the region of the 
heart ” I have often noticed this symptom, ivliieh is very readily recog- 
nized after being once peiceived, although it is difficult to give a descrip- 
tion of it The neaiest idea I can give of it is by comparing it to the 
pulling of a eat when pleased The same sort of quality is said, by M 
Coivisait, to exist in the pulse, which, he adds, is weak, but without hard- 
ness 01 fullness To these symptoms may be added those characteristics 
of hypeitiophia and dilatation of the left auiicle and whole right side of 
the heart, which usually follow the affection of the valve 

I must confess that I have never perceived the peculiar charactei of the 
pulse described by JI Coivisart, and that I have frequently found want- 
ing the peeuliai vibration in the region of the heait in eases of undoubted 
disease of the ^alves I believe the latter sensation is only perceptible by 
the hand when the conti action of the orifice is very considerable In os- 
sification of the sigmoid valves, seveial signs deduced from the state of 
the cuculation aie given by M Coivisait, but the whole may be i educed to 
the inunng sensation above mentioned 

Since I have used the cvlindei I ha\e onlv met with thiee cases of os- 
sification of the initial \alve accompanied by the pun mg sensation, and 
onlv foul cases of the same affection of the sigmoid in a slight degiee, and 
unattended In the puinng In companng these, howeiei, with the nu- 

[ 359 ] 



meroiis cases 1 had befoie studied, I think I can give the following le- 
sults, if not collect, as, at least, appioaching to coiieetness 

Ossifieation of the initial and sigmoid valves does not piodiice iiiegu- 
larity of the cii dilation, and cannot theiefoie be suspected fiom the 
state of the pulse, oi bj^ the application of the hand to the legion of the 
heait, unless it is so consideiable as mateiially to lessen the oiifiees of the 
left ventiicle In ossification of the initial valve, in a middling degree, 
the sound which attends the coiiti action of the auiicle becomes much moie 
piolonged, moie dull, and with something in its tone which reminds one of 
the lasping of a file on wood, and sometimes of a bellows smartly com- 
pressed This sound is well-maiked when the pinung is not perceptible to 
the hand, but it is much moie distinct when this is peieeptible, and is, in- 
deed, proportional to its intensity 

The ossification of the sigmoid valves of the aoita is shewn b-y the ex- 
istence of this sound dining the contraction of the ventricle, but this does 
not exist in slight degrees of the affection, noi in a similai condition of the 
mitial 

111 these cases, as in dilatation and hvpeitiophia, the alternate exam- 
ination of the heart under the steinum and belveen the cartilages of the 
fifth and seventh iilis, as well as the state of the external lugulais, will al- 
ways enable us to decide nr which side of tlie heai t tlie disease exists 

OF ACCIDENTAL OR EXTRANEOUS PRODUCTIONS 
IN THE HEART' 

Of all the organs of the body the heart is perhaps the least liable to 
these productions, if we except ossifications Twice only have I found 
tubercles in its nrusculai substance, and not once melanosis, medrrllaiy 
sarcoma, oi any other sjiecies of cancer M Recaraiei, however, iiifoims 
me that he has found the heart partially converted into a sen i Irons mattei 
resembling laid, in a peison who also had cancers in the lungs In the 
Sepulchi etum we find several examples of tumours in the heart, which ap- 
pear to have been cancerous Columbus found two hard tumoius of the 
size of an egg in the paiietes of the left ventricle t Morgagni relates a 
ease where there were numerous small tubeicles on the external surface of 
the light auricle, in a subject which exhibited similar, but larger, trrmorris 
in the nrediastinum, lungs, lymphatic glands, and cellular substance of the 
thorax and abdomen (Epist 78 ) 

Encysted serous tumours are equalty rare in this viserrs When they do 
occur they are most commonty found between the muscular substance and 
investing pericardium Examples have been recorded by Baillou, Horiliei, 
Coidaeus, Rolfinckius, Thebesius, Panton, Dalsalva, Morgagni, and Drrpuj"- 
tren The latter found cysts of this kind in the paiietes of the light auricle, 
projecting inwardly, and distending it to a size equal to the whole of the 

♦Book Third Chapter 1, Section Thirteenth See footnote on page 332— F A W. 1910 

tDe re Anat lib XV r ocm 



otliei paits of tlie lieait Moigagm describes a tiimoiii, wliicli ivas evi- 
dently a liydatid, implanted on tlie sin face of the left ventiiele (Bpist 21), 
and winch appeals to have been that vaiiety named by Kiidolphi Cyshcei ous 
fiiinus 

OF POLYPI OF THE HEART ^ 

It was foimerly customary to attiibute to the polypous concretions of 
the heait obseived aftei death, the symptoms which truly depend on the 
enlargement of that oigaii The incoiieetness of this opinion is proyed 
by the fact, that these concietions aie yeiy fiequently found in peisons who 
haye never exhibited any symptom of disease of the lieait in tiutli, they 
aie met with in thiee-fouitlis of dead bodies It is equally eironeous to 
believe, with some modem authors, that polypi never begin to foiin until 
the moment of death Many facts piove that these concietions can be 
formed during life The phenomena of aneurisms alone prove this Haller 
found the carotid artery and internal ougular vein quite obstructed by 
very firm concrete fibiine in one ease, and the inferior vena cava in an- 
other t Vinckleijt Stancari and Banaioli have met with similar cases § 

I have myself obseived, nr a consumptive subject, an obliteration of the 
inferioi cava for the space of four fingers’ bieadth This obstruction was 
produced by a whitish fibrinous concretion which filled the whole caliber 
of the vein The exterior layers of this concretion were like the huffy coat 
of the blood, only much firmer, and adhered strongly to the inner coat of 
the vein, the inner portions were, on the contrary, of a yellowish colour, 
more completely opaque, and of a friable charactei like certain kinds of 
cheese In another case I found a similar obstruction in the carotid artery , 
and, in a third, I observed the whole of the vessels of the pia matei, in a 
ciicumsciilied space about the size of the palm of the hand, injected with a 
similar concietion None of these individuals had exhibited any symptoms 
indicative of such an affection, nor did there exist nr anj’- of them any ob- 
stacles to the course of the blood which might account for them we must, 
therefore, attiilnite them to spontaneous coagulation of the blood, and 
reasoning, a prion, therefore, nothing is more probable than that the blood 
may coagulate during life, in the heait also, at least at the very close of 
life, vheii the ciiculation is peifoimed only nr an irregular and imperfect 
manner M Corvisait i\as therefore correct m distinguishing polypi into 
such as are of a formation posteiioi to death, and such as hare been pro- 
duced while the individual vas still alive These two kinds aie easily dis- 
tinguished from each othei Tlie formei, or those of recent formation, 
exhibit meiely a slight laiei of vlntish opaque fibnne partially em eloping 
the coagula of blood contained in the heait and laige vessels This fibrinous 
or biiflv lar ei neier conipletelv suiiounds the coagula, and does not adlieie 

•Book Third Chipterl Section Toui tocnth ‘^ec footnote on page 332 FA tv 1910 

-tOpu-sc P ithol obs 23 21 
JDIssoit tie Vasor lithias 
SMorg-ipnl Epist 04 


[ 361 ] 



to the paiietes of the heait oi vessel in winch it is contained Sometimes 
this layer is thickei, and, in this case, especially if the subject is dropsical, 
it IS semi-tiansparent and ti emulous like jelly 

On the other hand, the polypi of nioie ancient foimation are of a much 
firmei consistence, and adheie more oi less stiongly to the parietes of the 
heait In the ventiicles and auricular sinuses, this adliesion is partly 
caused, no doubt, by the inteite\tuie of the concietion with the columnae 
carneae, but, even heie, the piineipal pait of the attachment is independent 
of any mechanical stiuctuie of the paits These concietions are of a more 
distinctly fibiinous textuie than aie the leceiit foimations or the huffy 
coat of the blood, and tlic^ aie, fuithei, of a pale flesh oi slight violet 
colour, while the moie iccent aie, as alieady mentioned, of a white oi yel- 
lowish eoloui 

These ancient concietions aie found most fiequently in the sinus of the 
right aiiiiele, and in tlic light ventiiele WJien in tlie foimei, they com- 
pletelj’’ obstiuct its cavil j, but in the ventiicle they onij’- double in thick- 
ness its paiietes (theieby lessening its cavity) and obstiuct the descent 
of the tiicuspid valve In this case, one may ienio\ e all the loose coagulated 
blood without injuiing the concietion, it is even possible that this might be 
mistaken foi the natuial boundaiies of the cavity 

The columnae caineae to winch these concietions aie attached, are com- 
monly peiceptibly flattened, a eiicumstance wliicli, of itseK, would prove 
then foimation to be anteiioi to death Coivisait was the fiist, as far 
as I luiow, to obseive tins flattening of the columnae, in the case noticed by 
him thej'- weie quite effaced I have not met witli any case so strongly 
maiked as tins, but it is by no means laie to And cases wheiein the thing 
IS veiy perceptible 

Theie is stiU a thud species of concietion, evidently moie ancient than 
those just deseiibed, — of a foimation, peihaps, seveial months anterioi 
to the patient’s death These aie found adheiing to the paiietes of the 
heait, sometimes so fiimly as only to be detached by sei aping with the 
scalpel Then consistence is less than that of those just noticed , being not 
at all fibiinous, and lesembling lathei a diy f liable paste oi a fat and 
somewhat soft cheese They have lost the semitianspaiency of leceiitly eon- 
cieted fibiine, and lesemble in eveiy lespect those layeis of decomposed 
fibiine met with in false aneuiisms I have only met with concietions of 
this kind in the auricles 

OF EXCRESCENCES ON THE VALVES AND INTERNAL 
PARIETES OF THE HEART 

There are two veiy distinct vaiieties of this affection The fiist has been 
described by M Coivisait undei the name of Exci escences of the Valves^ 
the other, which does not appeal to have been hitherto deseiibed, I shall 

♦Book Third Chapter 1, Section Fifteenth See footnote on page 332 — F A W, 19i0 

[362 ] 



notice under tlie name of glohulm exciescence The fiist kind might very 
well be named waity exciescence, inasmuch as they aie extiemely like warts, 
especially those of veneieal origin on the parts of generation Like these, 
the exciescences in the heart sometimes resemble small cheiries, in their 
form and tubeious siuface, at othei times they aie elongated into the form 
of a small eylmdei oi eoid, and, occasionally, they aie so short and so 
crowded together, as meiely to give to the paits on which they aie situated 
a lough 01 rugged suifaee, more frequently, hoivevei, thej^ aie either iso- 
lated or ranged in a single line along the loose, or the attached bordei of 
the valves I have never observed any longer than thiee lines The colour 
of these excrescences is sometimes whitish like that of the valves, and hardly 
so opaque, moie commonly they aie eithei whoUj’’ or in part tinged with a 
1 eddish or light violet colour Then texture is fleshy, hke venereal warts, 
only of somewhat less firm consistence They adheie immediately to the 
sub3acent parts, sometimes so strongly as to be only separable by incision, 
more commonlj'' they are easity removed by scraping The venereal origin 
of these excrescences, entei tamed by M Corvisait, appears to me very im- 
probable, when we consider their rarity and the fieqiiency of venereal com- 
plaints, and when ive meet with them, as we do, in individuals who, in all 
probabilit3’', never had this disease Whatever may be the remote cause of 
these bodies, the manner of their formation seems to me more explicable 
In dissecting the more voluminous exciescences, it has always appeared to 
me that then texture has home a strong resemblance to that of the more 
compact polypous concietions Fiequently we observe m their centre a 
violet or sanguineous tint , and sometimes I have even found a very small, 
but distinct, coagulum of blood Piom these circumstances I am led to 
believe, that these excrescences are merely polypi organized by the same 
piocess which transforms the false albuminous membranes into true ad- 
ventitious membianes, oi into cellular substance 

In like manner as M Corvisart, I have only met with these exciescences 
in the following situations, viz the mitral, tricuspid, and sigmoid valves, 
and (much more raiely) the interior of the auricles, especially the left 
In general they are more common m the left than the right side of the 
lieait I may liere lemaik that the view of the foimation of these excies- 
eenees, given abore, proves that thej'^ are not likelj’’ to occur but in sub- 
jects already affected with some serious disease of the heart or large ves- 
sels, a cueumstance, as we shall find, in another place, vhicli must lendei 
their diagnosis ^elv difficult [In the following notice of a ease of this 
affection, I sliall, as in many of the former cases, omit several of the sjmip- 
toms with the intention of again noticing them in another part of this 
voik ] 

Case 43 A man, aged thntv-fi\e, at the period of his coming into 
hospital, liad been affected for five months, vith great di’spnoea and violent 
palpitations on making anv consideiable exeition, staitings from sleep, and 

[300] 



occasional spitting of blood For a few days past he had laboiiied iindei 
a seveie diaiihoea Hi& countenance uas tianquil, with some coloni, the 
pulse small, liaid, and legulai, and the lespiiation oppiessed The action 
of the lieait was not quite legulai, but theie was no distention of the jngn- 
lar veins This patient died on tlie thud day 

The peiicaidiuiii contained half a pint of seium The heait was double 
the size of the patient’s fist Tlic light veiitiicle was veiy laige, its paiietes 
being at least foiii lines thick, and its eolumnae veiy laige The tiicuspid 
valves, and the sigmoid of the pulmonaiy aitei3", weie of a deep violet led 
eoloui The right auricle was sound The left ventricle was one-thud 
laigei than natuial, and its walls weie six lines tliick, and its eolumnae \en 
thick One of the tendons affixed to the edge of the initial "valve vas iiip 
lined about its middle Tins luptuie appealed to haie been the conse- 
quence of piogiessive wasting of its middle pait, and one of the othei 
tendons of the same valve was unequally extenuated, but still vhole The 
whole floating boidei of the mitial valve yas eovexed vith small excies- 
cenees such as I have desciibed, imiying in size, foim, and consistence 
Altogethci they gave to the lahe a thickened and fiinged appeaiance 
The sigmoid valves of the aoita, and the lining meinbiane of this aiten, 
weic extiemcly led, and exhibited in this lespeet a stiiking contiast with 
the iiinei membiaiie of the ventiicle Tlie wliole innei siufaee, and indeed 
the whole paiietes, of the left aiuicle, veie of tlie same led coloui, and, 
above the opening of the left pulmonaiy veins, and about two lines fioni 
the auiieulo-vcntiiculai opening, theie was about an inch squaie coated 
ivith a congeiies of exciescences similai to tliose on the mitial vahe, and 
veiy fiimly attached Tlie museulai substance of the heait was of iiiodeiate 
fiimness The pleuia contained about a pint of seium on each side Tlie 
lungs weie sound 

The globulai exci esccnccs have a quite difteient appeaiance fiom those 
3ust desciibed, lesembling little balls oi c’vsts, of a spheiical oi oval shape, 
and of a size fiom that of a pea to a pigeon’s egg The exteiioi suiface of 
these IS equal, smooth, and of a yellowish white coloui, and the thickness of 
then paiietes is veiy unifoira, being nevei moie than half a line The sub- 
stance composing then paiietes is opaque and veij'" siiinlai to that of 
ancient poljqn, its consistence being fiimei than boiled white of egg The 
inner surface of these paiietes (the cyst) is not so smooth as the exteiioi, 
and it appears to be composed of a softei substance, which occasionally has 
the appeaiance of passing gradually into the mattei contained within it 
This mattei may exist in thiee diffeient states, all of Avhieh may be found 
in the same subject, but in diffeient cysts These aie, fiist, a liquid re- 
sembling half-coagulated blood, only tuibid as if iiiteimixed with some 
insoluble powdei, and sometimes containing a few clots of peifectly coagu- 
lated blood, second, a moie opaque mattei, of a pale violet coloui, of a 
pultaceous consistence, and veiy like the lees of 'wiiie, and thud, yellov 

[ 364 ] 



ish, opaque fluid, like thick pus oi thin paste I have onty met with cysts 
of this kind m the ventricles and auiiculai sinuses They aie found as fie- 
quently m the light as left side of the heart, geneially neai the apex of the 
ventiicles, and always adheient to the walls of the cavity They aie at- 
tached by means of a pedicle, which is often so slightly connected with tlie 
columnae caineae as to be detached from them without being ruptured 
This pedicle, although forming part of the excrescence, resembles the com- 
mon polypi more than the other portions, and seems as if it iveie of more 
recent formation and less perfectly organized I have never found these 
bodies more organized than I have described, and I have considered those 
containing clots of blood as the newest, those containing a fluid like the lees 
of wme as next in order, and those containing a puiifoim matter as the 
most ancient I have met with these excrescences in subjects dead of dif- 
ferent diseases, but all of whom had remained in a dying state (agonie) 
tor several days or even weeks 

The only case that I have met with in medical writings, which seems to 
me to agiee with the above description, is recorded in the M\scd Nairn 
Cunos The affection, nevertheless, does not appeal to be extremely rare, 
as I have met with several cases of it 

OF THE RED COLOUR OF THE INTERNAL MEMBRANE OF 
THE HEART AND LARQE VESSELS-^’ 

In examining dead bodies we frequently find the inside of the aorta and 
puhnonary artery uniformly reddened, as if stained by the blood they con- 
tained This colouring is of two kinds, — eithei bordering on scarlet, or 
violet The scarlet colour has its seat exclusively in the inner membrane, 
as, when this is removed, the tunic beneath is found of the natural colour 
This colour rs quite uniform, as if painted, without any trace of vascularity, 
onty sometimes more intense in one place than another Sometimes this 
stain diminishes progressively from the origin of the aorta, but frequently 
It ter inmates quite abruptly with ii regular edges Sometimes in the mid- 
dle of a very red portion we find a eiicumsciibed spot retaining the natural 
white colour, like the whiteness produced by pressure with the finger on an 
erysipelatous skin The origin and arch of the aorta are the situations 
most commonly reddened, and, with them, the sigmoid and mitial valves 
^Yhen the pulmonary artery is affected, its vahes, as well as the tricuspid, 
are commonly in the same state The lining membiane of tlie rentiicles 
and auricles is frequently colourless vhen the rahes are deeply stained, 
not infiequentty, hovevei, the auricle participates m the affection, but 
scarcely ever the ventricles This redness is attended by no sensible thick- 
ening of the part, and it entiielv disappears after a few lioiiis maceration 

jM CoiMsait has slightlv noticed tins affection, and lias aroued his ig- 
iioiaiiee of its nature and cause Fianck, vho has obsened it thiouch the 

'Book rhiul Cli iptci 1 ‘?tction 'SixUcnth Svc footnote on inpro 332 — B V %v lO^o 

[ 365 ] 



whole tiact of the aiteries, consideied it as the cause of a paiticulai and 
unifoiml3^ fatal fever M3" own obscivations aie fai fiom leading to the 
same result, although I confess inj-’self ignorant of the natuie of this af- 
fection The most natural idea respecting it is, that it is the result of in- 
flammation But mere redness, without thickening of parts, does not suffi- 
cientlj" chaiaeterise this state, while the abiupt termination, and exact 
circumscription presented b^' the redness in ceitam cases, seem not easily 
to accord with the natuie of inflammation On the othei hand, it may, in- 
deed, be said, that m the serous and mucous membranes, tins soit of redness 
by" stains is more chaiacteiistie of inflammation than the mere sanguineous 
iiifaietion of the eapillaiies, which might take place eilhei at, or after, 
death The following is an example of this affection 

Case 44 A 3"oung woman, fiesb-colouied and plump, came into hospital 
complaining only of intense headache, of three davs’ duiation At the 
end of two da3"s the disease assumed the appeaianee of acute hydioeephalus, 
the pulse being very" slow, very icgulai and of model ate strength The 
cerebral sy"mptoms inei easing lapidh, this patient died at the end of ten 
day"s from the invasion of the disease, aftei the application of the usual 
measures, and particularly the emploMnent of a gieat number of general 
and local bleedings indicated by the Molencc of the headache Foi two 
day"s before death, the pulse became moie frequent, but not stiongei, noi 
more irregular On examining the body", besides the hydrocephalus, there 
were found tubercles in the lungs, large tuberculous ulcerations in the in- 
testines, extensive emplnsema m scAcial poitions of the mucous coat of 
the intestines, unequivocal maiks of eonfiimed lues, and, finally", a very 
intense redness of all the vahcs of the heart, the aorta, and particularly of 
the pulmonary" artery" 

One of my" pupils informs me that he found 111 an aorta intensely red- 
dened, some small purulent collections, lesembling miliaiv pustules, situ- 
ated between the internal and middle coats This, however, must have been 
the consequence of disease of the middle coal, itself, as we can haidly" sup- 
pose that inflammation of the internal coat ■would terminate in suppuiation 
of its adherent surface I do not, howevei, mean to deny the possibility of 
inflammation of blood-vessels On the contiaiy", I think it probable that 
the affection, we have been deseiibing is of this natuie, and I would be 
disposed to consider the various concretions of blood already" mentioned, 
for example, those which produce obliteration of -veins, and the -warty 
excrescences, as the result of inflammation 

The second species of ledness of the laige vessels has a quite different 
appearance, being, in place of a bright red, of a violet hue It is also 
usually extended at the same time to the aoita, pulmonary aitery", valves, 
auricles and ventricles This vaiiety is not so exactly" confined to the 
lining membrane, as we find the muscular substance of the auricles and 
ventricles, and even the fibrinous coat of the aorta and pulmonary artery, 

[366 ] 



paiticipating in it, at least paitially I have found this vaiiety of colouring 
in subjects dead of putiid feveis, emphysema of the lungs, and disease of 
the heart All these individuals had lemained long in a inoiibund con- 
dition, with suftocation , and I have thought that the violent tint was deep 
in pioportion to the intensity and diuation of the lattei symptom Fiom 
this ciicumstance I am disposed to eonsidei this condition of the vessels 
as the etfeet of deianged eiiculation and congestion of the blood m the 
capillaiies, being analogous to the livid hue of the cheeks, etc observable 
in persons dead of disease of the heart It is, in fact, an effect of death, 
01 at most pioduced in aiticulo moitis 
I would heie beg to obseive, that it is often difficult to distinguish mere 
congestion of the capillaiies fiom actual inflammation The distinction, 
howevei, is of gieat importance, both in moibid anatomy and piactical 
medicine, the more so, as both these affections may exist simultaneously 
In proof of this I may refer to the controversy that has for some time ex- 
isted respecting the condition of the mucous membiane of the intestines 
111 fevei 

I am far fiom denjnng the influence of irritation, ulceration, aphthae, 
and consequent inflammation of the intestinal tunics in continued fevers , 
and, although they have been more oi less noticed and appreciated in all 
ages, M Bioussais has truly benefited his piofession by calling the at- 
tention of piaetitioneis more paiticulaily to them, and by showing the in- 
juiious eiioi of foimei peiiods in withholding the employment of geiieial 
and local bleedings in fever s But we should fall into as great, although 
an opposite, eiioi, if ive concluded that all continued feveis depended on 
the intestinal nutation that accompanied them, and that eveiy kind of 
redness observable in them after death indicates a disorder lequirmg 
venesection foi its tieatment The mucous membiane of the stomach and 
bowel is iiatuially pale only in persons of pale skins, its degree of coloui 
may be judged of by that of the lips, mouth, aims and vulva, in different 
individuals No one will set down the livid gums of a dropsical oi 
scorbutic patient, or the swelling and blueness of his hands and feet, to 
inflammation, or think of treating these affections bj’- blood-letting Now, 
111 manv cases, I coneen e, the redness of the mucous coat of the intestines 
has much more relation to this passive congestion than to inflammation 
If, then, such appearances (as is most probable) onlj’- took place m such 
subjects, at the same time as the lividity of the face and of the dependent 
paits of the bodj' — that is to say, some days oi hours before death, it 
would be absurd to look to such condition of parts for the cause of the 
feiei, — moie especiallv, as A\e often find, in such cases, traces of as 
great oi gi eater disoidei in almost e\eiy texture of the body Foi ex- 
ample —the skin is diy and haish, the lips, gums, and lining membiane 
of the mouth aic swollen, soft and chopped, the membranes of the brain 
aie goiged with blood and containing seiiiin, the lungs are chaiged with 

[ *507 1 



a seio-sangumolent fluid, the mucous membiane ol the bionchia is swol- 
len and of a violet hue, the heait is flaccid, livid and soft, the blood fluid 
and impel fectly coagulable, the lining membiane of the arteiies oi veins 
hvid as if stained by blood, the muscles fishy (poisseux) , the spleen en- 
laiged, the capillaiies of almost eveiy oigan, and oi the suifaee, gorged 
with blood, and lastlj’-, the intestines aie in the same state, and then lining 
membiane livid, ulceiated and thickened in diveise places — Now, to which 
of these affections shall we attiibute the disease^ All aze posteiior— often 
many days — to the fevei Is it not, tlieieioie, moie lational to coiisidei, 
that none of these local lesions aie tlic cause, but that, as in smallpox and 
measles, some unlaiown cause, acting gcnciallv on the system, had pioduced 
both the lever and the local affections — whethei active oi passive — which ac- 
company 01 follow it^ 

In the veiy case wheie theie exists simultaneously aphthae and exiileeia- 
tions in the intestinal tunics, and ledness, lividity, and capillaij’’ congestion 
of the mucous membiane, we ought to conclude, fiom analogy, that the two 
formei states aie the ^lesult of inflammation, active oi passive, — and the 
tliiee lattei the lesiilt of debility of the eiieulation ui the capillaiies, that 
the fiist may lequiic venesection, but that this veiy means, earned to too 
great lengths, ma} give use to, oi ineiease the last, by inci easing the gen- 
eial debility Tlie haematemosis and blood fluxes ivhicli occur sometimes in 
continued feveis ought lathci, m my opinion, to be attiibuted to purely 
passive congestions of the capillaiies, than to inflammation In the in- 
stance just mentioned v e find the whole of the intestinal tunics in the af- 
fected pait tinged vith blood, and softened, without any notable increase 
of thickness of the pait, wdiile inflammation of eveiy mucous membrane 
unifoiml}’’ incieases both the thickness and density of the pait AVe may 
faitliei add the fine obseivation of' Bichat, that, of any moibid affection, 
inflammation has the least tendency to piopagate itself by contiguity, es- 
pecially 111 membianous paits Peiitonitis and dysentery leave untouched 
the museulai coat of the intestine, but the lividity consequent on fatal 
feveis often extends to the whole three tunics 

OF MALFORMATION OF THE HEART 

There exist two varieties of unnatuial communication between the 
cavities of the heart, viz the iieifoiation of the septum of the ventiieles, 
and the continued patency of the foramen of Botalliis The first variety 
is very rare, there being not more than five or six instances of it on leeoid 
In all these the unnatuial aperture was smooth, evidently veiy ancient, if 
not congenital The continued patency of the foramen of Botallus is iniieli 
more common Sometimes this is pioduced by the imperfect union of the 
two plates of the foetal valve, so that a probe, or even a female sound, can be 
passed obliquely from one auricle to the other This condition of paits is 

«Boolv Third, Chapter 1 Section Se^enteenth See footnote on page 332 — F A W 19-10 

[3(58 1 



Hot veiy laie, and does not appeal to be piodnctive of any kind of incon- 
venience In otliei cases we find the foiameii continue constantty open so 
as to admit the fingei I have myself seen it sufficiently laige to recene 
the thumb It is commonly believed that this species of malfoiniation is 
always congenital, but fioni some cases which I have met with, I am dis- 
posed to believe that such a perfoiation may be produced by an accident, 

01, at least, when such a condition of paits exists as above desciibed, that 
a blow, fall, or violent exertion, may cause the dilatation of the oblique 
opening, and its progiessive enlargement The histoiy of seveial cases on 
lecoid, especially of some of M Coivisait’s, would seem to countenance this 
opinion, since, in seveial of these, the individuals had enjo3’'ed good health, 
without aiij'" sj^^mptom of diseased heait, until they had experienced some 
of the accidental causes above mentioned 

I do not know that any of these unnatuial communications have existed 
without consequent thickening and dilatation of either the whole, or part of 
the heart, especially the light side The sj^mptoms of the latter affection 
aie, consequentlj’’, combined with those of the foimei These aie prin- 
cipally the foul following 1, a gieat sensibility to the impression of cold, 

2, frequent faintings, 3, the lespnation more constantly impeded than m 
most othei diseases of the heait, and 4, a violet or blueish colour of the 
skin much moie extensive than that in anj’’ other disease, and, sometimes, 
even geneial This last symptom has been named by seveial authors the. 
Hue jaundice, oi the blue disease On the other hand, all the above men- 
tioned sjonptoms have been found to exist in subjects who had no othei 
malfoimation than the continued patencj’’ of the foiamen of Botallus, and 
still moie so in those cases ivheie the puhnonaij’’ aiteiy ivas found to oiigi- 
nate in the left \eiitiicle, and the aoita in the light, oi where the latter has 
opened at once into both ventiicles In some diseases of the lungs, es- 
pecially emphysema, the blue coloui of the skin is sometimes quite as in- 
tense and as extensive as in the case of malfoimation of the heait On the 
othei hand, the foiamen of Botallus has been found dilated very eonsider- 
ablv, without theie being present any degree of lividity except on the face 
and extiemities The ease of dilatation noticed by myself, above mentioned, 
was of this soit 


OF DISPLACEMENT OF THE HEART 

The lieait, although letained in its place In the diaphiagm, laige i&ssels, 
and peculiai stiuctuie of the mediastinum, and, still moie, by the constant 
stale of plenitude of the chest, maj, ncvci theless, in ceitain cases, be tin on n 
to the light 01 left by a solid, liquid, or aciifoim effusion into either sac 
of the pleiua, In extensue tumouis in the lungs, and, as ve ha\e alieadv 
seen, hv cmplnsema of this oigan In like mannei, a tunioui in the su- 
poi 101 m ediastinum oi a huge anemism of the aich of the aoita, maA pi ess 

•Book Thiril Chiptor 1 Section IliKhtot-nth See footnote on pnpc 3C2 P \ n into 

[ ICO ] 



it downwaxds, so that that pait of the diaphiagm on which it i eposes shall 
project into the abdomen Sometimes even this depiession has taken place 
without any visible cause, in which case the affection has been named by 
some authois piolapsus of the lieait 

These vaiioiis kinds of displacement pioduce no peiceptible incon- 
venience when they exist in a slight degiee, when moie maiked, they may 
produce bad effects, hut in this case, they aie themselves consequences of 
lesions much more seiious 

CHANQES PRODUCED BY DISEASES OF THE HEART IN 
THE TEXTURE OF OTHER ORQANS^ 

On examining the bodies of peisom who have fallen victims to organic 
affections of the heait, besides the oiganic lesion and the seious effusions 
which almost alwaj^s accompany it, we find all the maiks of congestion of 
blood in the internal capillaiies The mucous membianes, especially those 
of the stomach and intestines, aie of a led oi violet tint, and the liver, 
lungs, and capillaiies situated beneath the seious, mucous and cutaneous 
tissues, aie goiged with blood The augmented coloiii of the mucous mem- 
bianes vanes much in degiee and extent Sometimes it is obseived only 
heie and theie, undei tlie foini of small points oi specks, disseminated ovei 
the suiface of the membiane at othei times it occupies the whole extent 
of the surface, and has the appeal ance of being attended by some swelhng 
of the pait These two lattei appearances aie sometimes so considerable, 
that, if we looked to tliem meiely, without examining the condition of the 
heait, and without lefeience to the histoiy of the patient (who had been 
found capable of taking into Ins stomach wane and othei stimulant matters 
without expel lencing any pain, even up to the peiiod of his death), we 
might be tempted to belle^e that the fatal disease had been a violent in- 
flammation of the stomach and bowels In fact, the degiee of ledness of 
the membianes observed aftei diseases of the heait, is often much moie 
intense and extensive than is found aftei tiue inflammation of these paits, 
as, foi example, in dysenteiy, a fact, among many othei s, sufficiently 
pioving the insufficiency of mere ledness to characterise inflammation of the 
mucous membrane of the intestines 

Lancisi and Senac, aftei Hildanus, considei gangrene of the limbs, as a 
consequence of disease of the heait and large vessels The late M Giraiid 
was of the same opinion, and, since his time, many piaetitioneis have con- 
sidered the gangiene of old peisons as usually caused by ossification of the 
aiteries M Coivisait justly doubts whethei, in such cases, theie is any- 
thing else but mere coincidence of independent diseases , and I think that 
the single circumstance of the larity of the spontaneous gangiene of the 
limbs, compaied Avith the fiequency of disease of the heait and ossification 
of the aiteries, is sufficient to lender the thing quite impiobable This is 

♦Book Third Chapter 1 Section Nineteenth See footnote on page 332 — F A W 19^0 

[370 ] 



equally the case with the notion of Testa, that ophthalmia, and sometimes 
the loss of the eye, may be ranged among the consequences of diseases of 
the heart * 

OF THE CAUSES OF DISEASES OF THE HEARTt 

The causes of diseases of the heait are, like the diseases themselves, 
vaiious in their natuie Ossifications aie the lesult of some aberration of 
the process of assimilation which is not easily understood I have already 
stated my opinion respecting the origin of the excrescences on the valves 
The dilatation and thickening of the ventricles, diseases of much greater 
frequency, also may arise from numerous causes, but these are in general 
more easily traced to their effects, than the former AE diseases which 
give rise to severe and long-continued dyspnoea produce, almost necessarily, 
hyper tiophia or dilatation of the heart, through the constant effoits the 
organ is called on to perform, in order to propel the blood into the lungs 
against the resistance opposed to it by the cause of dyspnoea It is in this 
manner that phthisis pulmonalis, empyema, chronic peiipneumony, and 
emphysema of the lungs, act in producing disease of the heart, and that 
those kinds of exeicise which require great exertion, and thereby impede 
respiration, come to be the most common remote causes of these complaints 

On the other hand, it is found that diseases of the heart, on the same 
principle of mutual influence, give rise to several diseases of the lungs 
They are thus among the most frequent causes of oedema of the lungs and 
haemopt3’’sis "When, however, diseases of the heart are found to coexist 
with chronic pleiuisy, phthisis, emphvsema, and, in general, with chronic 
disease of the lungs, it will usualty be found, on close examination, that 
the latter are the piimaij' diseases It follows fiom these, and other facts 
noticed under the head of Emphysema and Pulmonary Catarrh, that a 
neglected Cold is frequently the original cause of the most severe diseases 
of the heart 

To all these causes must be added the congenital disproportion between 
the swe ol the heart and the diametci of the aorta M Coivisait has, per- 
haps, gone too far in asserting that theie can be no dilatation of the heart 
u it bout the pievious existence of a dispiopoition of this kind, or of a 
conti action, or some similar obstruction of the circulation, at a greater oi 
loss distance from the heart, it is, hoAiCAei, true, that it is Aery common to 
find an aoita of small diametei in eases of hjqieitiophia or dilatation of 
the heait Still, this is not aluays the case, and houever rational such a 
cause mav be ue can leadih' conceive manj’ otheis We know that the 
01101 getic and leiteiatod action of all muscles notablj' iiiei eases their 
M/o as 111 the case of those of the light aim of the fencer, the shoulder of 
the poilei, and the hands of most artisans On the same piineiple we 

•Oillo Mill ittk till Cuon BoloKn » ISIO 

thoia Thiril diiptirl ''fction TMintKth footnote on p i„< 332 f \ W l'>in 

[ '711 



must admit that even neivous palpitations, oi such as oiigmate fiom 
11101 al causes, may, by fiequent lecunence, pioduce a true enlargement 
of the heal t 

Theie is yet anothei congenital cause of disease of the heart, which 
appeals to me to be of gieatei fiequency than the small calihei of the 
aorta, above mentioned, — I allude to a dispiopoitionate thickness of one oi 
both sides of the lieait I am satisfied that in a gieat many persons the 
paiietes of one oi both sides of the heait aie eithei too thick oi too thin 
fiom biith In such eases tlicie can be no doubt that the usual exciting 
causes will be moie apt to pioduec foimal disease of the heait than in 
individuals in whom this dispiopoilion does not exist 

CHAPTER 11 DISEASES OF THE PERICARDIUM 
Of Pencai diiis, oi InflammaUon of the Pcnccn dtum 

Peiieaiditis is inflammation of the seious membiane which lines the 
fibrous sac of the peiieaidiiim, the heait, and laige ^essels It may 
be eithei acute oi chionic This inflammation, like that of all membranes 
of the same kind, is niaikcd by icdness, moie oi less deep, a concrete 
albuminous exhalation and a seio-puiulent etfusion The ledness is al- 
most always but slight in the acute disease When it exists, it is foi the 
most pait only paitially It is most commonly j^imctuated, and looks 
as if the suiface of the membiane was coveied, heie and theie, with little 
specks of blood veiy close to each othei I hai e nevei peiceived that this 
redness was accompanied by any thickening of the pait In some cases, 
wheiein, to judge by the thickness of tlie false membianes, the inflamma- 
tion appeals to have been Aeiy gieat, no ledness whatevei can be dis 
coveied on the seious membiane, on lemoval of the membianous exuda- 
tion This conciete albuminous exudation commonly invests the whole 
suiface of the peiicaidium, as ivell on the heait and large vessels, as on 
the sac It laiely piesents the appeal ance of an equable membianous 
layer, like the false membianes of pleuiisy, on the contiaiy, its surface 
IS most fiequently maiked by a gieat niimbei of lough and iriegiilar 
piominences Sometimes the knobbed appeal ance of this exudation is 
very like what would lesult fiom the sudden sepaiation of two pieces of 
slab joined by a pretty thick layei of buttei , at other times, it is moie 
like the internal suiface of the second stomach of the calf, an observation 
made, in one case, by M Coivisait In ceitain cases this aspect of the 
false membiane has given use to a singulai eiioi, haAung been mistaken 
foi a vaiioloiis eiuption in subjects dead of the small-pox The consist- 
ence of this exudation is usually gieatei than that of the false membranes 

*Bo^c Third Chapter 2, Section First See footnote on pag-e 332 — F A W 1940 

[ 372 ] 



of pleurisy, it is also tliickei, and moie fiimly adlieieiit to tlie suboaeeiit 
parts, its coloiii is, liowevei, the same, being of a pale yellow analogous 
to that of pus 

The seium effused in iiiflamination of the peiicaidium is limpid, of a 
pale yellow eoloui, oi slightly biowmsh It contains few fragments of 
senii-conciete albumen, at least, it veiy laiely contains enough of these 
to give it a milky and tuibid chaiactei The quantity of this elfusion is 
usually consideiable m the commencement of the disease, often as much 
as a pound M Gorvisait found it, in one ease, to amount to four pounds 
It would seem that the quantity of effused seium diminishes quickly, as 
soon as the violence of the inflammation begins to subside , as we usually 
find the piopoition of seium and of albuminous exudation neaily equal, 
while 111 pleurisy and peiitonitis the seium is commonly from twenty to 
fifty times gieatei than that of the extiavasated lymph Veiy commonly 
even, in veiy violent cases, we find no effused seium, and only a thick 
and highly eoneiete albumen filling the whole cavity of the pericardium, 
and uniting the heait and laige vessels to the exteiior oi loose poition 
of this membrane In this case we may suppose that the effused seium 
has been quickly absoibed, and the two layeis of false membiane 
cemented togethei , although it is not impossible that, in some eases, the 
more solid exudation may be the only one AVe have seen that the same 
thing occasionally takes place in ceitain paitial and sub-acute inflamma- 
tions of the pleuia, and seveial obseivations have led me to believe that 
the eaitilagmous patches that sometimes aie met with on the exteiioi of 
the lungs aie pioduced in the same mannei 
AVhen the disease teiminates favouiably, the pseudo-membranous 
exudation, aftei a ceitain time, is conveited into cellulai substance, or 
lathei into laminae of the same natuie as the seious membianes, that is 
to say, the laminae aie double, the exteiioi suiface being exhalent, and 
the inteiioi cellulai, oi adherent, and containing the vessels distributed 
to the pait Sometimes these laminae aie long, sometimes so shoit that 
the peiicardium seems intimately adherent to the heait 
Befoie the convex sion of false membianes into cellulai tissue was well 
understood, the adhesion of the peiieaidium to the heart was legarded by 
diveis authois as a cause of vaiious and serious complaints Lancisi and 
Abeussens considered it as constantly causing palpitation, Meckel, as 
lendeimg the pulse habitually small, and Senac, as productive of fie- 
quent famtings Even M Coivisait himself has fallen into some mis- 
takes on this head He admits thiee species of adhesions, — all of which 
I haxe .lust desciibed as meie vaiieties oi stages of the same affection 
These aie, fiist, a semieoneiete albuminous adhesion, which is the only 
one lecoginsed by him as the consequence of peiicaiditis, second, the 
len intimate oi close cellulai adhesion, deemed an effect of gouty oi 
iheumatic affections, and thud, the extended or long cellular adhesion, 

[ 373 ] 



the cause of which is not assigned by linn ' M Coivisait is fuither of 
opinion that no pei son can live, and pi esei ve a good state of health, who 
IS affected with a complete and close adhesion of the peiieaidnim to the 
heait, 01 of the lungs to the pleuia 

I have, howevei, met with many cases wheie this condition of paits was 
found aftei death, in which no disoidei of the lespiiation oi ciiciilation 
existed duiing life A case adduced by M Coivisart in support of his 
opinion (Op cit p 34) appeals to me lathei conclusive against it, inas- 
much as the appeal ances on dissection show^ed sufficient lesions in other 
organs to account foi the symptoms icfeiied by him to the adhesions be- 
tween the heart and pencaidium 

Sometimes, though laiely, the inflammation is confined to a pait onlj' — 
sometimes a veiy small pait — ot the pencaidium These pailial inflamma- 
tions aie in pioportion to the gencial, in point of fiequencj, haidly as one 
to ten Then anatomical chaiaeteis aie picciselj' the same, only that the 
albuminous exudation is in them confined to the inflamed pait The seious 
effusion IS sometimes as abundant as in the geneial disease, more com- 
monly, howevei it is less The inflammation in this case almost alva'^s 
teiminates in being ciued, bv the tiansloimation oi the pseiido-membianoiis 
exudation into long seious laminae, scaicely e\ei aie these paitial inflam- 
mations followed by the intimate adhesion of the paits 

We fiequentlv find on the suiface of the heait opaque vliite patches, 
sometimes as laige as the palm ot the hand, moie commonly one-half oi one- 
thiid this size, and often veiv small They aie neaily of the thicluiess of 
the nail, and have a degiee of consistence equal to that of the membianes 
composed of condensed cellulai substance, as, foi instance, the exterioi 
membiane of the lymphatic glands They adheie so closely to the paits 
on which they lie, that it is difficult to asceitain, even by dissection, whethei 
they aie situated above oi beneath the fine membiane coveiiiig the heait 
and great vessels M Coivisait is of opinion that they aie beneath it I 
have, howevei, aseei tamed the incoiieetness of this opinion, as I have 
seveial times been able to lemove the patches, leaving the seious membiane 
of the pericardium still untouched 

Aie these patches the effect of iiaitial 2 ieiicaiditis and the consequent 
conversion of the effused lymph into a condensed memhianoiis cellulai 
tissue^ M Corvisait consideis them as jiroduced without pievious in- 
flammation, and seated, as I have alieady said, beneath the seious siiifaee 
of the pencaidium Both these notions aie, I think, inadmissible, inas- 
much as there exists no example of an albuminous exudation on the 
adherent surface of a seious membiane, and as facts without number piove 
that pseudo-membianous exudations aie always the piodiice of inflamma 
tion 

♦See Tieatise on the Heait etc, bj M Corvisait 

[374] 



I have lately met with a ease which appears to me to throAV some light 
on the question of the oiigin of these spots In a man dead of peri- 
pneumony, I found a thin false membiane, veiy fiim and of a yellowish 
colour, investing the right auricle and a poition of the ventricle of the 
same side, all the rest of the peiicaidium being quite free, only containing 
m its cavity two or thiee ounces of a transparent and slightly yellow 
seium Some parts of the false membiane, particularly on the auiicle, were 
of a wliitei colour and fiimer than the rest, and exhibited an appearance, 
almost the same as the white patches above described 
Chrome peiicaiditis is always general occupying the whole internal sui- 
face of the seious membiane This is commonly much redder than in the 
acute disease The redness is formed by the close appioximation of 
minute points, which look as if applied with a pencil Raiely the chronic 
disease is accompanied by a pseudo-membianous exudation, and when this 
exists, it IS thin, soft, f liable, and entirely lesembling a layei of very thick 
pus In evei}’’ ease there exists a moie or less copious effusion of a tuibid, 
milkj’' fluid, sometimes having quite a purifoim chaiacter I am led to be- 
lieve that the close adhesion of the pericaidium to the heait, is commonly 
the consequence of the absorption of this fluid, and that the adhesion by 
the long laminae is the product of the acute disease In one case I found 
a close and general adhesion of the pericardium to the heart and large 
vessels, by means of a false fibro-caitilaginous membiane, in every respect 
lilce those of the pleura 

Piom one case, cited by M Corvisart, I am led to believe, that theie 
may occasionally aiise, subsequently to chionic inflammation of the peii- 
eaidium, a tubeiculous eiuption similai to those frequently foimed in the 
false memlnanes of the pleuia and peritoneum "The poitioii of the peri- 
cardium,” he says, "which invests the heart, was of a greyish colour, 
thickened, unequal, wimkled, cusp, and containing gianulations of which 
the summit seemed ulceiated ” I am the rathei led to consider these 
giannlahons as tubeicles, because m the same subject "both lungs, al- 
though cieiiitous, weie gianulai thioughout ” 

In manj'’ eases of peiicaiditis, especially in the chioiiic disease, the 
musculai substance of the heart has lost its coloui and become whitish 
This loss of coloiu IS sometimes attended by a notable degiee of softening, 
and, at other times, the consistence is natiiial Most wiiteis have legaided 
this loss of coloui as a maik of the inflammation of the heait itself, and most 
of the examples leeoided of Caiditis aie meiely cases of inflammation 
of the pericaidium accompanied by this loss of colour A gieat number of 
those collected bv 51 Coivisait aie of this kind Foi my oun pait I am 
disposed to doubt the coiieetness of the opinion that refeis this loss of 
coloui to inflammation We can iicA'ei be sine of the existence of inflam- 
mation in a musculai oigan unless ue find a deposition of pus among its 
fibi es 


[ 375 ] 



PERICARDITIS 

1 Acute Pencarditis Theie are few diseases attended by more variable 
symptoms, or of moie difficult diagnosis, than tins >Sometimes it appeals 
with all the symptoms of a veiy violent disease of the chest, at other 
times it proves fatal without leading us, in the least, to suspect its 
existence Again, we find eases ma